Special Issue "Traumatic Brain Injury: Recent Developments and Emerging Trends"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (30 April 2021).

Special Issue Editor

Prof. Dr. Olli Tenovuo
E-Mail Website
Guest Editor
Turku Brain Injury Center; University of Turku and Turku University Hospital; Turku, Finland
Interests: diagnostics of TBI; pathophysiology of TBI; treatment and rehabilitation of TBI

Special Issue Information

Dear Colleagues,

Traumatic brain injury (TBI) is a vast global health burden, which still lacks proper data on many crucial aspects, from reliable pathophysiological classification to targeted treatments. There has been an exponential increase in the number of publications on TBI, but the transfer of research findings from science to the clinic is frustratingly slow. Big international efforts hold promise for producing true advances for the diagnostics and care of TBI patients. TBI is a clinical problem that regards several specialties, from emergency and intensive care to rehabilitation and psychiatry. Therefore, reports on the scientific progress in this field are scattered throughout numerous journals with different, often narrow focus, making it difficult to obtain a complete picture of the current status of TBI medicine and related emerging trends. The development of technical solutions in laboratory medicine, imaging, and neurophysiology has been extremely rapid, providing us with new tools with numerous potential clinical applications. In few areas in medicine is the need for personalized medicine and for the use of artificial intelligence greater than in TBI, which is the most complex individual disease. Despite all innovative technologies and new application possibilities, the everyday care of TBI has made little progress during the last two decades and is still largely based on the personal experience and views of the treating clinician. The present Special Issue aims to provide an up-to-date review of TBI for all those healthcare professionals who meet and treat TBI patients at various levels and in different facilities. The focus of this Special Issue is on clinically relevant recent developments and emerging trends, with the aim to give the reader a good understanding of the current state of TBI medicine.

Prof. Dr. Olli Tenovuo
Guest Editor

Manuscript Submission Information

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Keywords

  • Epidemiology
  • Clinical challenges and caveats
  • Pathophysiology and classification
  • Biomarkers
  • Imaging
  • Genetic aspects
  • New and emerging treatments
  • Long-term sequels

Published Papers (7 papers)

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Research

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Article
Evaluation of Intracranial Hypertension in Traumatic Brain Injury Patient: A Noninvasive Approach Based on Cranial Computed Tomography Features
J. Clin. Med. 2021, 10(11), 2524; https://doi.org/10.3390/jcm10112524 - 07 Jun 2021
Viewed by 510
Abstract
Background: Our purpose was to establish a noninvasive quantitative method for assessing intracranial pressure (ICP) levels in patients with traumatic brain injury (TBI) through investigating the Hounsfield unit (HU) features of computed tomography (CT) images. Methods: In this retrospective study, 47 patients with [...] Read more.
Background: Our purpose was to establish a noninvasive quantitative method for assessing intracranial pressure (ICP) levels in patients with traumatic brain injury (TBI) through investigating the Hounsfield unit (HU) features of computed tomography (CT) images. Methods: In this retrospective study, 47 patients with a closed TBI were recruited. Hounsfield unit features from the last cranial CT and the initial ICP value were collected. Three models were established to predict intracranial hypertension with Hounsfield unit (HU model), midline shift (MLS model), and clinical expertise (CE model) features. Results: The HU model had the highest ability to predict intracranial hypertension. In 34 patients with unilateral injury, the HU model displayed the highest performance. In three classifications of intracranial hypertension (ICP ≤ 22, 23–29, and ≥30 mmHg), the HU model achieved the highest F1 score. Conclusions: This radiological feature-based noninvasive quantitative approach showed better performance compared with conventional methods, such as the degree of midline shift and clinical expertise. The results show its potential in clinical practice and further research. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
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Article
The Association of Post-Concussion and Post-Traumatic Stress Disorder Symptoms with Health-Related Quality of Life, Health Care Use and Return-to-Work after Mild Traumatic Brain Injury
J. Clin. Med. 2021, 10(11), 2473; https://doi.org/10.3390/jcm10112473 - 02 Jun 2021
Viewed by 549
Abstract
Patients with mild traumatic brain injury (mTBI) are at risk for post-concussion (PC) symptoms and post-traumatic stress disorder (PTSD). The co-occurrence of PC and PTSD symptoms after mTBI in relation to health-related quality of life (HRQoL), health care utilization, and return to work [...] Read more.
Patients with mild traumatic brain injury (mTBI) are at risk for post-concussion (PC) symptoms and post-traumatic stress disorder (PTSD). The co-occurrence of PC and PTSD symptoms after mTBI in relation to health-related quality of life (HRQoL), health care utilization, and return to work has not yet been investigated. PC and PTSD symptoms were measured six months post-TBI by respectively the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). Of the 1566 individuals after mTBI who met the inclusion criteria, 26.1% experienced PC symptoms (RPQ ≥16). Additionally, 9.8% experienced PTSD symptoms (PCL-5 ≥ 33), of which the vast majority (81%) also reported experiencing PC symptoms. Differences between patients with no/mild symptoms, with only PC, only PTSD, and both PC and PTSD symptoms in HRQoL, return to work, and rehabilitation were analyzed using logistic and linear regression analyses. Patients with PC and/or PTSD symptoms reported lower HRQoL, higher rates of rehabilitation, and lower return to work rates compared to patients with no/mild symptoms. Patients with both PC and PTSD symptoms reported significantly lower HRQoL (B = −2.73, CI = −4.65; −0.83, p < 0.001) compared to those with only PC symptoms, while there were no significant differences in their ongoing rehabilitation care (OR = 1.39, CI = 0.77–2.49, p = 0.272) and return to work rates (OR = 0.49, CI = 0.15–1.63, p = 0.246) at six months. These results underline the importance of the diagnosis and appropriate treatment of patients with mTBI, experiencing PC and/or PTSD symptoms. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
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Article
Apolipoprotein ɛ4 Status and Brain Structure 12 Months after Mild Traumatic Injury: Brain Age Prediction Using Brain Morphometry and Diffusion Tensor Imaging
J. Clin. Med. 2021, 10(3), 418; https://doi.org/10.3390/jcm10030418 - 22 Jan 2021
Viewed by 528
Abstract
Background: Apolipoprotein E (APOE) ɛ4 is associated with poor outcome following moderate to severe traumatic brain injury (TBI). There is a lack of studies investigating the influence of APOE ɛ4 on intracranial pathology following mild traumatic brain injury (MTBI). This study explores the [...] Read more.
Background: Apolipoprotein E (APOE) ɛ4 is associated with poor outcome following moderate to severe traumatic brain injury (TBI). There is a lack of studies investigating the influence of APOE ɛ4 on intracranial pathology following mild traumatic brain injury (MTBI). This study explores the association between APOE ɛ4 and MRI measures of brain age prediction, brain morphometry, and diffusion tensor imaging (DTI). Methods: Patients aged 16 to 65 with acute MTBI admitted to the trauma center were included. Multimodal MRI was performed 12 months after injury and associated with APOE ɛ4 status. Corrections for multiple comparisons were done using false discovery rate (FDR). Results: Of included patients, 123 patients had available APOE, volumetric, and DTI data of sufficient quality. There were no differences between APOE ɛ4 carriers (39%) and non-carriers in demographic and clinical data. Age prediction revealed high accuracy both for the DTI-based and the brain morphometry based model. Group comparisons revealed no significant differences in brain-age gap between ɛ4 carriers and non-carriers, and no significant differences in conventional measures of brain morphometry and volumes. Compared to non-carriers, APOE ɛ4 carriers showed lower fractional anisotropy (FA) in the hippocampal part of the cingulum bundle, which did not remain significant after FDR adjustment. Conclusion: APOE ɛ4 carriers might be vulnerable to reduced neuronal integrity in the cingulum. Larger cohort studies are warranted to replicate this finding. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
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Article
Health-Related Quality of Life Trajectories across 10 Years after Moderate to Severe Traumatic Brain Injury in Norway
J. Clin. Med. 2021, 10(1), 157; https://doi.org/10.3390/jcm10010157 - 05 Jan 2021
Viewed by 626
Abstract
Traumatic brain injury (TBI) has a long-lasting impact on participation and health-related quality of life (HRQL). We aimed to describe the physical and mental health trajectories and to identify their predictors across the first 10 years after TBI. A prospective longitudinal cohort of [...] Read more.
Traumatic brain injury (TBI) has a long-lasting impact on participation and health-related quality of life (HRQL). We aimed to describe the physical and mental health trajectories and to identify their predictors across the first 10 years after TBI. A prospective longitudinal cohort of 97 individuals with moderate to severe TBI (age 16–55 years) in Norway were followed up at 1, 2, 5, and 10 years post-injury. Their socio-demographic and injury characteristics were recorded at baseline; their responses to the 36-Item Short Form Health Survey (SF-36) were collected at each follow-up. The Physical (PCS) and Mental Component Summary (MCS) scores were used as the outcome measures of physical and mental health. The predictors of the trajectories were described and examined using hierarchical linear modelling. The subscale scores showed a stable or increasing trend, but only the Role Physical and Role Emotional subscales showed clinically relevant positive changes from 1 to 10 years post-injury. Longer time, male gender, employment pre-injury, and shorter length of post-traumatic amnesia were significant predictors of better physical health trajectories; longer time, male gender, and employment pre-injury were significant predictors of better mental health trajectories. At-risk individuals may be targeted to receive rehabilitation interventions to improve their long-term quality of life outcomes. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
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Article
Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe
J. Clin. Med. 2020, 9(6), 2007; https://doi.org/10.3390/jcm9062007 - 26 Jun 2020
Cited by 1 | Viewed by 1437
Abstract
Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI [...] Read more.
Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
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Review

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Review
Assessing the Severity of Traumatic Brain Injury—Time for a Change?
J. Clin. Med. 2021, 10(1), 148; https://doi.org/10.3390/jcm10010148 - 04 Jan 2021
Cited by 2 | Viewed by 1207
Abstract
Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current [...] Read more.
Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current classifications are primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. Brain imaging results have also been used, yet there are multiple ways of doing brain imaging, at different timepoints in this very dynamic injury. Severity itself is a vague concept. All prediction models based on combining variables that can be assessed during the acute phase have reached only modest predictive values for later outcome. Yet, these early labels of severity often determine how the patient is treated by the healthcare system at large. This opinion paper examines the problems and provides caveats regarding the use of current severity labels and the many practical and scientific issues that arise from doing so. The objective of this paper is to show the causes and consequences of current practice and propose a new approach based on risk classification. A new approach based on multimodal quantifiable data (including imaging and biomarkers) and risk-labels would be of benefit both for the patients and for TBI clinical research and should be a priority for international efforts in the field. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
Review
Optimal Timing of External Ventricular Drainage after Severe Traumatic Brain Injury: A Systematic Review
J. Clin. Med. 2020, 9(6), 1996; https://doi.org/10.3390/jcm9061996 - 25 Jun 2020
Cited by 1 | Viewed by 1640
Abstract
External ventricular drainage (EVD) may be used for therapeutic cerebrospinal fluid (CSF) drainage to control intracranial pressure (ICP) after traumatic brain injury (TBI). However, there is currently uncertainty regarding the optimal timing for EVD insertion. This study aims to compare patient outcomes for [...] Read more.
External ventricular drainage (EVD) may be used for therapeutic cerebrospinal fluid (CSF) drainage to control intracranial pressure (ICP) after traumatic brain injury (TBI). However, there is currently uncertainty regarding the optimal timing for EVD insertion. This study aims to compare patient outcomes for patients with early and late EVD insertion. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, MEDLINE/EMBASE/Scopus/Web of Science/Cochrane Central Register of Controlled Trials were searched for published literature involving at least 10 severe TBI (sTBI) patients from their inception date to December 2019. Outcomes assessed were mortality, functional outcome, ICP control, length of stay, therapy intensity level, and complications. Twenty-one studies comprising 4542 sTBI patients with an EVD were included; 19 of the studies included patients with an early EVD, and two studies had late EVD placements. The limited number of studies, small sample sizes, imbalance in baseline characteristics between the groups and poor methodological quality have limited the scope of our analysis. We present the descriptive statistics highlighting the current conflicting data and the overall lack of reliable research into the optimal timing of EVD. There is a clear need for high quality comparisons of early vs. late EVD insertion on patient outcomes in sTBI. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
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