Impact of day-of-injury alcohol consumption on outcomes after traumatic brain injury: A meta-analysis

Although a known risk factor for traumatic brain injury (TBI), alcohol has been found to both promote and protect against secondary brain damage. However, it is presently unclear whether the cognitive, psychological and medical/functional outcomes of adults who have consumed alcohol prior to sustaining a TBI differ from those who have not. This meta-analysis examined the outcomes of groups that differed in terms of their day-of-injury (DOI) blood alcohol levels (BALs) by comparing positive with zero BAL (BAL⁺/BAL^-) and high with low BAL (BAL^high/BAL^low) samples. The PubMed, PsycINFO, EMBASE, and Scopus databases were searched from inception until the end of March 2015. Hedge’s g effects (continuous data) and odds ratios (categorical data) were calculated for 27 studies that compared either the outcomes of BAL⁺ and BAL^? groups or BAL^high and BAL^low groups. BAL⁺ was associated with significantly poorer cognitive outcomes (overall and on general tests) and higher levels of disability, and BAL^high was associated with shorter stays in intensive care. More generally, however, most effect sizes were small to low-moderate in size, non-significant and inconsistent in their direction. Although DOI alcohol consumption increases the risk of sustaining a TBI, it is not consistently associated with better or worse outcomes, other than subtle cognitive deficits; the source of which remains to be determined.     

乙醇对颅脑创伤预后影响的研究进展

颅脑创伤(TBI)已成为世界范围内一个重要的公共卫生问题,高死亡率和致残率给社会和家庭带来沉重的经济负担.早在1985年,美国全年因TBI所造成的经济负担就达378亿美元,现巳升至每年600亿美元.我国交通伤是发生TBI最主要的原因[1],而机动车交通伤发生的主要原因是酒后驾车.     

A meta-analysis of treating acute traumatic brain injury with calcium channel blockers

The purpose of this systematic review was to evaluate and meta-analyse the current evidence for the use of calcium channel blockers (CCBs) in the treatment of acute traumatic brain injury (TBI) and traumatic subarachnoid haemorrhage (tSAH). A systematic search of clinical trials.gov, Cochrane library databases, EMBASE, MEDLINE, Web of science search and WHO trial registry, plus hand-searching of grey literature, was undertaken in March 2013. Two reviewers independently extracted the data using a pre-defined data extraction form. RevMan 5 software was used to synthesise data and calculate the risk ratio (RR) based on event rates as well as the 95% confidence interval (CI). Finally, nine RCTs with a total of 2182 patients were included. Meta-analysis showed that there was no difference between CCBs and control groups for rates of mortality (n = 1337, 5 RCTs, RR 0.93 CI 0.77–1.12). In a subgroup tSAH analysis, the difference was not significant (n = 389, 2 RCTs, RR 0.73 CI 0.53–1.02). There were slightly fewer unfavourable outcomes in the treatment group, but the difference was not statistically significant (n = 2101, 8 RCTs, RR 0.90 CI 0.76–1.08). In the subgroup tSAH analysis, again, the difference did not reach statistical significance (n = 1074, 5 RCTs, RR 0.95 CI 0.73–1.24). It seems that larger, well-designed RCTs are necessary in order to ascertain any clinical benefit CCBs may or may not have for the treatment of acute TBI.     

Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes

Purpose: To investigate the relationship between traumatic brain injury (TBI) and psychogenic nonepileptic seizures (PNES). We hypothesized that PNES with TBI would be associated with more psychiatric comorbidities and disability than PNES without TBI. Methods: In this cross‐sectional study comparing patients with PNES with TBI to patients with PNES without TBI, medical records from 255 consecutive patients with electroencephalography (EEG)‐confirmed PNES were reviewed to assess variables including demographic, head injury, neurologic, psychiatry, social variables, and quality of life and symptoms scales. Parametric, analysis of covariance (ANCOVA), and logistic regression analyses were performed, to compare psychiatric and function variables between the two study groups while controlling for age and sex. Key Findings: Of the 92 patients with PNES who fulfilled inclusion/exclusion criteria, 41 (44.6%) had a history of TBI. Of the 41 patients with TBI, 30 (73%) met criteria for mild TBI (mTBI). Patients with TBI had more mood disorder diagnoses, were more likely to receive disability, and had lower global functioning than non‐TBI patients with PNES, after adjusting for age and sex. Patients with TBI and PNES had significantly increased odds for having major depression, behavioral impulsivity, posttraumatic stress disorder diagnosis, and a trauma/abuse history. Significance: TBI is a significant risk factor in patients with PNES, being associated with increased psychiatric diagnostic comorbidity, symptoms severity, poorer functioning, and increased disability. This study reveals the importance of identifying and addressing the impact of TBI in patients with seizure disorders. Addressing the sequelae of TBI in PNES may be a target to improve functioning.     

正中神经电刺激对创伤性颅脑损伤昏迷促醒作用的Meta分析

目的系统评价正中神经电刺激（MNS）对创伤性颅脑损伤（TBI）昏迷促醒作用。 方法全面检索Pubmed、Web of Science、Embase、The Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库及维普数据库收录的关于MNS治疗与常规昏迷促醒疗法治疗TBI昏迷患者的随机对照试验,检索时间均自建库至2022年3月。由2名研究者按照纳入与排除标准进行文献筛选、数据提取和质量评价。按照干预措施的不同,将患者分为常规治疗组和MNS组,常规治疗组采用常规治疗方法,MNS组在常规治疗方法的基础上采用MNS治疗。采用Stata12.0软件进行Meta分析的合并效应量计算、异质性检验和发表偏倚检验。 结果本研究纳入21篇文献,共计1684例患者。Meta分析结果显示,治疗1、2、3、4周后,与常规治疗相比,MNS可以提高患者GCS评分（P<0.001）,且苏醒率更高（OR=2.13,95%CI：1.56~2.91）。MNS组的脑功能障碍评分（SMD=-0.66,95%CI：-0.96~-0.36）低于常规治疗组,运动能评分（SMD=0.25,95%CI：0.00~0.50）、生活质量评分（SMD=0.85,95%CI：0.53~1.18）、EEG评分（SMD=1.04,95%CI：0.23~1.86）均高于常规治疗组。 结论MNS能够改善4周内TBI昏迷患者意识水平,具有促进清醒的作用。     

Traumatic brain injury causing intestinal dysfunction: A review

Traumatic brain injuries (TBI) and its sequelae are becoming one of the most pressing public health concerns worldwide. It is one of the leading causes of increased morbidity and mortality. The primary insult to the brain can cause ischemic brain injury, paralysis, concussions, death, and other serious complications. Brain injury also involves other systems through a secondary pathway resulting in multiple complications during and after hospitalization. The focus of our article is to assess the literature available on traumatic brain injury and intestinal dysfunctional to highlight the aspects of epidemiology, pathophysiology, and different diagnostic approaches for early diagnosis of gut dysfunction. We review studies done in both humans and animals, to better understand this underrated topic, as it costs billions of dollars to the healthcare industry because of delayed diagnosis.     

Problem alcohol use in veterans with mild traumatic brain injury: Associations with cognitive performance and psychiatric symptoms

Introduction: Given that little is known about the associations between alcohol use, cognition, and psychiatric symptoms among veterans with a history of mild traumatic brain injury (mTBI), we aimed to (a) characterize how they differ from veteran controls on a measure of problem drinking; (b) investigate whether problem drinking is associated with demographic or mTBI characteristics; and (c) examine the associations between alcohol use, mTBI history, psychiatric functioning, and cognition. Method: We assessed 59 veterans (n = 32 with mTBI history; n = 27 military controls) for problem alcohol use (Alcohol Use Disorders Identification Test: AUDIT), psychiatric symptoms, and neuropsychological functioning. Results: Compared to controls, veterans with mTBI history were more likely to score above the AUDIT cutoff score of 8 (p = .016), suggesting a higher rate of problem drinking. Participants with mTBI history also showed elevated psychiatric symptoms (ps < .001) and lower cognitive scores (ps < .05 to < .001). Veterans with higher AUDIT scores were younger (p = .05) and had less education (p < .01) and more psychiatric symptoms (ps < .01), but mTBI characteristics did not differ. After controlling for combat and mTBI history (R² = .04, ns) and posttraumatic stress disorder (PTSD) symptoms (ΔR² = .08, p = .05), we found that higher AUDIT scores were associated with poorer attention/processing speed, F(9, 37) = 2.55, p = .022; ΔR² = .26, p = .03. Conclusions: This preliminary study suggested that veterans with mTBI history may be at increased risk for problem drinking. Problem alcohol use was primarily associated with more severe PTSD symptoms and poorer attention/processing speed, though not with combat or mTBI characteristics per se. Importantly, findings emphasize the importance of assessing for and treating problematic alcohol use and comorbid psychiatric symptoms among veterans, including those with a history of neurotrauma.     

Factors affecting increased risk for substance use disorders following traumatic brain injury: What we can learn from animal models

Recent studies have helped identify multiple factors affecting increased risk for substance use disorders (SUDs) following traumatic brain injury (TBI). These factors include age at the time of injury, repetitive injury and TBI severity, neurocircuits, neurotransmitter systems, neuroinflammation, and sex differences. This review will address each of these factors by discussing 1) the clinical and preclinical data identifying patient populations at greatest risk for SUDs post-TBI, 2) TBI-related neuropathology in discrete brain regions heavily implicated in SUDs, and 3) the effects of TBI on molecular mechanisms that may drive substance abuse behavior, like dopaminergic and glutamatergic transmission or neuroimmune signaling in mesolimbic regions of the brain. Although these studies have laid the groundwork for identifying factors that affect risk of SUDs post-TBI, additional studies are required. Notably, preclinical models have been shown to recapitulate many of the behavioral, cellular, and neurochemical features of SUDs and TBI. Therefore, these models are well suited for answering important questions that remain in future investigations.     

A comparison of functional outcomes in hypoxia and traumatic brain injury: a pilot study

We present our experience with 30 patients on functional outcomes of patients with anoxic brain injury (ABI, n = 15) due to cardiac etiologies from freestanding inpatient rehabilitation hospital. A convenience sample of patient with traumatic brain injury (TBI, n = 15) with similar demographic characteristic to ABI was used for comparison on indices of activity of daily living, cognition, mobility as well as other indices of functional prognosis such as hospital length of stay, cost and discharge predisposition. No statistical significant differences were found between the two groups on the presently employed outcome measures. This investigation supports the positive impact of inpatient rehabilitation for individuals with hypoxia of cardiac etiology. Future research comparing outcomes of ABI to TBI with larger, controlled trials is warranted.     

Factors involved in the development of subdural hygroma after decompressive craniectomy for traumatic brain injury. A systematic review and meta-analysis

Subdural hygroma (SDG) represents a common complication following decompressive craniectomy (DC). To our knowledge we present the first meta-analysis investigating the role of clinical and technical factors in the development of SDG after DC for traumatic brain injury. We further investigated the impact of SDG on the final prognosis of patients. The systematic review of the literature was done according to the PRISMA guidelines. Two different online medical databases (PubMed/Medline and Scopus) were screened. Four articles were included in this meta-analysis. Data regarding age, sex, trauma dynamic, Glasgow Coma Scale (GCS), pupil reactivity and CT scan findings on admission were collected for meta-analysis in order to evaluate the possible role in the SDG formation. Moreover we studied the possible impact of SDG on the outcome by evaluating the rate of patients dead at final follow-up and the Glasgow Outcome Scale (GOS) at final follow-up. Among the factors available for meta-analysis only the basal cistern involvement on CT scan was associated with the development of a SDG after DC (p < 0.001). Moreover, patients without SDG had a statistically significant better outcome compared with patients who developed SDG after DC in terms of GOS (p < 0.001). The rate of patients dead at follow-up was lower in the group of patients without SDH (8.25%) compared with patients who developed SDG (11.51%). SDG after DC is a serious complication affecting the prognosis of patients. Further studies are needed to define the role of some adjustable technical aspect of DC in preventing such a complication.     

Traumatic brain injury caregivers: A qualitative analysis of spouse and parent perspectives on quality of life

The objective of this qualitative study was to examine how family caregivers of individuals with traumatic brain injury (TBI) describe their quality of life in the context of their caregiving role. Fifty-two caregivers of adults with moderate or severe TBI (n?=?31 parents, n?=?21 partners/spouses; 77% female; mean age?=?57.96 years, range?=?34–78 years) were recruited from three data collection sites to participate in focus groups. Thematic content analysis was used to identify two main meta-themes: Caregiver Role Demands and Changes in Person with TBI. Prominent sub-themes indicated that caregivers are (1) overburdened with responsibilities, (2) lack personal time and time for self-care, (3) feel that their life is interrupted or lost, (4) grieve the loss of the person with TBI, and (5) endorse anger, guilt, anxiety, and sadness. Caregivers identified a number of service needs. A number of sub-themes were perceived differently by partner versus parent caregivers. The day-to-day responsibilities of being a caregiver as well as the changes in the person with the TBI present a variety of challenges and sources of distress for caregivers. Although services that address instrumental as well as emotional needs of caregivers may benefit caregivers in general, the service needs of parent and partner caregivers may differ.     

Posttraumatic stress disorder in OEF/OIF veterans with and without traumatic brain injury

Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are presenting with high rates of co-occurring posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The purpose of this study was to compare the clinical presentations of combat-veterans with PTSD and TBI (N = 40) to those with PTSD only (N = 56). Results suggest that the groups present two distinct clinical profiles, with the PTSD + TBI group endorsing significantly higher PTSD scores, higher overall anxiety, and more functional limitations. The higher PTSD scores found for the PTSD + TBI group appeared to be due to higher symptom intensity, but not higher frequency, across PTSD clusters and symptoms. Groups did not differ on additional psychopathology or self-report of PTSD symptoms or executive functioning. Further analysis indicated PTSD severity, and not TBI, was responsible for group differences, suggesting that treatments implicated for PTSD would likely be effective for this population.     

颅脑外伤后患者的智力水平及相关因素研究

目的　探讨颅脑外伤后患者的智力水平及相关因素。方法　对 55 例颇脑外伤后患者采用修订的韦氏成人智力量表(WAIS- RC)进行测评,并应用自制的颅脑外伤患者人口学及相关资料调查表进行调查,汇总资料进行整理、分析。所有统计分析均使用 SPSS -10.0 软件包完成。结果　颅脑外伤后患者言语智商(VIQ)(69.84±18.58)、操作智商(PIQ)(69.11±19.35)及总智商(FIQ)(66.36±17.58)均低于对照组,差异有极显著性。逐步回归分析揭示,影响言语智商的主要因素为脑外伤后昏迷时间;影响操作智商的主要因素为昏迷时间、年龄及伴有继发性癫痫;影响总智商的主要因素为昏迷时间、伴有脑电图异常、年龄及文化程度。结论　颅脑外伤后患者的智力水平较低,其影响因素涉及多个方面。     

颅脑外伤合并视神经损伤的临床研究

目的探讨颅脑外伤合并视神经损伤的病因、诊疗方案及影响预后的相关因素分析。方法回顾性分析我院124例颅脑外伤合并视神经损伤的临床病例资料,总结其诊治方法并通过单因素分析(χ2)观察影响预后相关因素。结果124例患者经治疗后总有效率为70.31%。手术治疗有效率为60%,药物治疗有效率为71.56%。意识障碍、视神经管骨折与预后无相关性(P0.05)。光感、治疗时间及VEP波形与视力恢复情况明显相关(P0.05)。结论视神经损伤治疗疗效较差,但早期诊断和治疗后仍能取得良好效果,目前仍以药物治疗为主,对有手术指证的应早期行手术治疗,以提高患者生存质量。     

Measuring the social interactions of people with traumatic brain injury and their communication partners: The adapted Kagan scales

Background: Considerable attention has been given to the nature of communication impairments of individuals with TBI (Coelho, 2007 Coelho, C. A. 2007. Management of discourse deficits following traumatic brain injury: Progress, caveats, and needs. Seminars in Speech & Language, 28(2): 122–135.  [Google Scholar]; Ylvisaker, Turkstra, & Coelho, 2005 Ylvisaker, M., Turkstra, L. S. and Coelho, C. 2005. Behavioral and social interventions for individuals with traumatic brain injury: A summary of the research with clinical implications. Seminars in Speech & Language, 26: 256–267. [Crossref], [PubMed] , [Google Scholar]). However, there have been few data focusing on the way communication partners deal with the often distressing sequelae of TBI.

Aims: This study reports inter- and intra-rater reliability of the Adapted Measure of Support in Conversation (MSC) and Measure of Participation in Conversation (MPC) for TBI interactions.

Method & Procedures: The MSC and MPC were adapted to reflect theoretical models of cognitive-communication support for people with TBI. A total of 10 casual and 10 purposeful TBI interactions were independently rated by two raters to establish inter-rater reliability and by one rater on two separate occasions to determine intra-rater reliability.

Outcomes & Results: Excellent inter-rater agreement was established on the MSC (ICC?=?0.85–0.97) and the MPC (ICC?=?0.84–0.89). Intra-rater agreement was also strong (MSC: ICC?=?0.80–0.90; MPC: ICC?=?0.81–0.92). Over 90% of all ratings scored within 0.5 on a 9-point scale.

Conclusions: This is the first scale to measure the communication partner during TBI interactions. It shows promise in evaluating communication partner training programmes.     

Temporal and spatial characterization of neuronal injury following lateral fluid-percussion brain injury in the rat

The pattern of neuronal injury following lateral fluid-percussion (FP) brain injury in the rat was systematically characterized at sequential time points to identify selectively vulnerable regions and to determine the temporal contribution of primary and delayed neuropathological events. Male Sprague-Dawley rats (n = 28) were killed 10 min, 2 h, 12 h, 24 h, 4 days, and 7 days following a lateral FP brain injury of moderate severity (2.2 atm), or 24 h after a sham injury. Brain sections were stained and analyzed using Nissl, acid fuchsin, and silver staining methods to identify regions with injured neurons or with visible lesions. Extensive numbers of acid fuchsin or silver-stained neurons were observed as early as 10 min after the FP brain injury in regions extending from the caudate/putamen to the pons. The frequency of injured neurons was greatest in the ipsilateral cortex, hippocampus, and thalamus, and a visible loss of Nissl-stained neurons was observed in these regions beginning at 12 h after the FP brain injury. Acid fuchsin-stained neurons were restricted to the same brain regions for all of the survival periods and gradually decreased in numbers between 24 h and 7 days after injury. These findings suggest that lateral FP brain injury in the rat produces a combination of focal cortical contusion and diffuse subcortical neuronal injury, which is present within minutes of the impact, progresses to a loss of neurons by 12 h, and does not markedly expand into other brain regions with survival periods up to 7 days. Furthermore, the acute onset and rapid evolution of the neuronal injury process may have important implications when considering a window of opportunity for pharmacological intervention. Received: 23 May 1995 / Revised, accepted: 15 September 1995     

颅脑损伤合并视神经损伤的诊治探讨(附18例报告)

目的探讨颅脑损伤合并视神经损伤的病因及其诊治经验。方法总结分析2007年9月至2010年3月收治的18例颅脑损伤合并视神经损伤患者的临床资料。结果手术治疗13例,8例视力恢复至伤前水平,4例入院时眼睛已经失明,术后未见好转,1例错过最佳手术时机,效果不佳;5例保守治疗,其中4例效果良好,1例入院时双眼失明,治疗后未见好转。结论颅脑损伤合并视神经损伤最常见的原因是视神经管骨折直接损伤视神经,治疗要把握手术指征和时机。