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Traumatic Brain Injury: Diagnosis, Management, and Outcomes
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Traumatic Brain Injury: Diagnosis, Management, and Outcomes

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 (31 December 2021) | Viewed by 15664

Special Issue Editor

Dr. Imoigele P. Aisiku

E-Mail Website
Guest Editor
Brigham & Women's Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA 02115, USA
Interests: traumatic brain injury (TBI); SAH; sepsis; ARDS

Special Issue Information

Dear Colleagues,

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Every year, about 1.5 million affected people die and several million receive emergency treatment after TBI. TBI is the leading cause of death in Americans under the age of 35 while the greatest increase in incidence occurs in persons greater than 74 years. The economic toll remains significant and continues to rise as high as $75 billion per year. The rate of effective treatment in clinical trials has yielded 30 negative trials in 25 years. However, our understanding of secondary mechanisms has grown with new scales of neurologic assessments, the use of multimodal monitoring, diagnostic imaging capabilities, neuroinflammation, and protocolized care, and rehabilitative innovations. In this Special Issue we will examine and review some of these advances as we continue to find therapeutic interventions to limit the secondary impact of TBI.

Dr. Imoigele P. Aisiku
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • traumatic brain injury
  • multimodal monitoring
  • epidemiology
  • clinical trials

Published Papers (6 papers)

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Research

23 pages, 1386 KiB  
Article
Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study
by Diego Rivera, Sven Greving, Juan Carlos Arango-Lasprilla, Nicole von Steinbuechel, Marina Zeldovich and CENTER-TBI Participants and Investigators
J. Clin. Med. 2022, 11(14), 4090; https://doi.org/10.3390/jcm11144090 - 14 Jul 2022
Cited by 4 | Viewed by 2316
Abstract
Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this [...] Read more.
Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months post-injury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes)
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12 pages, 835 KiB  
Article
The Role of Intraventricular Hemorrhage in Traumatic Brain Injury: A Novel Scoring System
by Cheng-Yu Li, Chi-Cheng Chuang, Ching-Chang Chen, Po-Hsun Tu, Yu-Chi Wang, Mun-Chun Yeap, Chun-Ting Chen, Ting-Wei Chang and Zhuo-Hao Liu
J. Clin. Med. 2022, 11(8), 2127; https://doi.org/10.3390/jcm11082127 - 11 Apr 2022
Cited by 4 | Viewed by 1556
Abstract
Traumatic intraventricular hemorrhage (tIVH) is associated with increased mortality and disability in traumatic brain injury (TBI). However, the significance of tIVH itself remains unclear. Our goal is to assess whether tIVH affects in-hospital mortality and short-term functional outcomes. We retrospectively reviewed the records [...] Read more.
Traumatic intraventricular hemorrhage (tIVH) is associated with increased mortality and disability in traumatic brain injury (TBI). However, the significance of tIVH itself remains unclear. Our goal is to assess whether tIVH affects in-hospital mortality and short-term functional outcomes. We retrospectively reviewed the records of 5048 patients with TBI during a 5-year period, and 149 tIVH patients were analyzed. Confounding was reduced using the inverse probability of treatment weighting (IPTW) based on propensity score. The association between IVH and outcomes was investigated using logistic regression in the IPTW-adjusted cohort. In our study, after adjustment for analysis, the in-hospital mortality rate (11.4% vs. 9.2%) and the poor functional outcome rate (37.9% vs.10.6%) were significantly higher in the tIVH group than in the non-tIVH group. Factors independently associated with outcomes were age ≥ 65 years, Glasgow Coma Scale (GCS) severity score, and the Graeb score. The Traumatic Graeb Score, a novel scoring system for predicting functional outcomes associated with tIVH, comprised the sum of the following components: GCS scores of 3 to 4 (=2 points), 5 to 12 (=1 point), 13 to 15 (=0 points); age ≥ 65 years, yes (=1 point), no (=0 points); Graeb score (0–12 points). A Traumatic Graeb Score ≥ 4 is an optimal cutoff value for poor short-term functional outcomes. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes)
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8 pages, 423 KiB  
Article
Dehydration Status at Admission Predicts Recurrence in Patients with Traumatic Chronic Subdural Hematoma
by Niklas Mainka, Valeri Borger, Alexis Hadjiathanasiou, Motaz Hamed, Anna-Laura Potthoff, Hartmut Vatter, Patrick Schuss and Matthias Schneider
J. Clin. Med. 2022, 11(5), 1178; https://doi.org/10.3390/jcm11051178 - 22 Feb 2022
Cited by 5 | Viewed by 1299
Abstract
Objective: There remains a significant risk of chronic subdural hematoma (CSDH) recurring after treatment. Patient-related predictors and surgical procedures have been investigated in many studies. In contrast, the literature remains scant on reports of the potential impact of dehydration on the admission of [...] Read more.
Objective: There remains a significant risk of chronic subdural hematoma (CSDH) recurring after treatment. Patient-related predictors and surgical procedures have been investigated in many studies. In contrast, the literature remains scant on reports of the potential impact of dehydration on the admission of affected patients and on the CSDH recurrence rate. Methods: All consecutively admitted patients with CSDH and surgical treatment at the authors’ institution between 2015 and 2019 were retrospectively identified. Dehydration was assessed as a blood urea/creatinine (U/Cr) ratio > 80. The association between dehydration on admission and postoperative complication rates, in-hospital mortality, and recurrence of CSDH, with the need for additional surgical treatment, was further analyzed. Results: A total of 265 patients with CSDH requiring surgery were identified. In 32 patients (12%), further surgery was necessary due to the recurrence of CSDH. It was found that 9 of the 265 patients with CSDH (3%) suffered from dehydration at the time of admission. Multivariate analysis revealed diabetes mellitus (p = 0.02, OR 2.7, 95% CI 1.2–6.5), a preoperative midline shift > 5 mm (p = 0.003, OR 3.3, 95% CI 1.5–7.5) and dehydration on admission (p = 0.002, OR 10.3, 95% CI 2.4–44.1) as significant and independent predictors for the development of CSDH recurrence that requires surgery. Conclusion: the present findings indicate that dehydration on admission appears to be an independent predictor for CSDH recurrence that requires surgery. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes)
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10 pages, 2627 KiB  
Article
Inflammatory Predictors of Prognosis in Patients with Traumatic Cerebral Haemorrhage: Retrospective Study
by Piotr Defort, Natalia Retkowska-Tomaszewska, Marcin Kot, Paweł Jarmużek, Anna Tylutka and Agnieszka Zembron-Lacny
J. Clin. Med. 2022, 11(3), 705; https://doi.org/10.3390/jcm11030705 - 28 Jan 2022
Cited by 5 | Viewed by 1979
Abstract
We aimed to evaluate the relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic inflammation index (SII), and Glasgow Coma Scale (GCS) score in patients with traumatic intracerebral haemorrhage (TICH). We retrospectively investigated 95 [...] Read more.
We aimed to evaluate the relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic inflammation index (SII), and Glasgow Coma Scale (GCS) score in patients with traumatic intracerebral haemorrhage (TICH). We retrospectively investigated 95 patients with TICH hospitalised at the Neurosurgery Department in Zielona Gora from January 2017 to March 2021. Routine blood tests were performed 5 h after injury. NRL and SII were significantly higher in patients with GCS ≤ 8 than patients with GCS > 8 and exceeded reference values in 95% of patients. GCS was inversely correlated with NLR and SII. Receiver operating characteristic (ROC) analysis confirmed the value of NLR and SII regarding GCS score; Area Under the Curve (AUC) 0.748, 95% Confidence Interval (CI) 0.615–0.880. An optimised NLR cut-off value of 0.154 was identified with a sensitivity of 0.90 and specificity of 0.56. The value of SII regarding GCS was confirmed with ROC curves; AUC 0.816, 95% CI 0.696–0.935. An optimised NLR cut-off value of 0.118 was identified with a sensitivity of 0.95 and specificity of 0.57. NLR and SII are significantly related to GCS scores and are promising predictors of clinical prognosis in TICH patients. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes)
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25 pages, 2290 KiB  
Article
Neutrophil-to-Lymphocyte Ratios and Infections after Traumatic Brain Injury: Associations with Hospital Resource Utilization and Long-Term Outcome
by Marina Levochkina, Leah McQuillan, Nabil Awan, David Barton, John Maczuzak, Claudia Bianchine, Shannon Trombley, Emma Kotes, Joshua Wiener, Audrey Wagner, Jason Calcagno, Andrew Maza, Ryan Nierstedt, Stephanie Ferimer and Amy Wagner
J. Clin. Med. 2021, 10(19), 4365; https://doi.org/10.3390/jcm10194365 - 24 Sep 2021
Cited by 7 | Viewed by 2697
Abstract
Traumatic brain injury (TBI) induces immune dysfunction that can be captured clinically by an increase in the neutrophil-to-lymphocyte ratio (NLR). However, few studies have characterized the temporal dynamics of NLR post-TBI and its relationship with hospital-acquired infections (HAI), resource utilization, or outcome. We [...] Read more.
Traumatic brain injury (TBI) induces immune dysfunction that can be captured clinically by an increase in the neutrophil-to-lymphocyte ratio (NLR). However, few studies have characterized the temporal dynamics of NLR post-TBI and its relationship with hospital-acquired infections (HAI), resource utilization, or outcome. We assessed NLR and HAI over the first 21 days post-injury in adults with moderate-to-severe TBI (n = 196) using group-based trajectory (TRAJ), changepoint, and mixed-effects multivariable regression analysis to characterize temporal dynamics. We identified two groups with unique NLR profiles: a high (n = 67) versus a low (n = 129) TRAJ group. High NLR TRAJ had higher rates (76.12% vs. 55.04%, p = 0.004) and earlier time to infection (p = 0.003). In changepoint-derived day 0–5 and 6–20 epochs, low lymphocyte TRAJ, early in recovery, resulted in more frequent HAIs (p = 0.042), subsequently increasing later NLR levels (p ≤ 0.0001). Both high NLR TRAJ and HAIs increased hospital length of stay (LOS) and days on ventilation (p ≤ 0.05 all), while only high NLR TRAJ significantly increased odds of unfavorable six-month outcome as measured by the Glasgow Outcome Scale (GOS) (p = 0.046) in multivariable regression. These findings provide insight into the temporal dynamics and interrelatedness of immune factors which collectively impact susceptibility to infection and greater hospital resource utilization, as well as influence recovery. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes)
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Graphical abstract

18 pages, 681 KiB  
Article
Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study
by Nada Andelic, Cecilie Røe, Olli Tenovuo, Philippe Azouvi, Helen Dawes, Marek Majdan, Jukka Ranta, Emilie I. Howe, Eveline J.A. Wiegers, Cathrine Tverdal, Ida Borgen, Marit V. Forslund, Ingerid Kleffelgaard, Hilde M. Dahl, Louis Jacob, Mélanie Cogné, Juan Lu, Nicole von Steinbuechel and Marina Zeldovich
J. Clin. Med. 2021, 10(5), 1035; https://doi.org/10.3390/jcm10051035 - 03 Mar 2021
Cited by 33 | Viewed by 4700
Abstract
This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the [...] Read more.
This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the CENTER-TBI study with severe-to-moderate disability. Impairments in five outcome domains (daily life activities, physical, cognition, speech/language, and psychological) and the use of respective rehabilitation services (occupational therapy, physiotherapy, cognitive and speech therapies, and psychological counselling) were recorded. Sociodemographic and injury-related factors were used to investigate the probability of receiving rehabilitation. Physiotherapy was the most frequently provided rehabilitation service, followed by speech and occupational therapy. Psychological counselling was the least frequently accessed service. The probability of receiving a rehabilitative intervention increased for individuals with greater brain injury severity (odds ratio (OR) 1.75, CI 95%: 1.27–2.42), physical (OR 1.92, CI 95%: 1.21–3.05) and cognitive problems (OR 4.00, CI 95%: 2.34–6.83) but decreased for individuals reporting psychological problems (OR 0.57, CI 95%: 1.21–3.05). The study results emphasize the need for more extensive prescription of rehabilitation services for individuals with disability. Moreover, targeted rehabilitation programs, which aim to improve outcomes, should specifically involve psychological services to meet the needs of individuals recovering from TBI. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes)
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