Journal of Neurotrauma
ISSN / EISSN: 08977151 / 15579042
Published by: Mary Ann Liebert Inc
Total articles ≅ 5,685
Latest articles in this journal
Journal of Neurotrauma; https://doi.org/10.1089/neu.2022.0410
Changes in demography and injury patterns have altered the profile and outcome of acute SCI over time. This study sought to describe recent trends in epidemiology and early clinical outcomes using the multi-center North American Clinical Trial Network (NACTN) for Spinal Cord Injury Registry. All participants with blunt acute traumatic SCI (n=782) were grouped into three 5-year time intervals from 2005 to 2019 (2005-2009, 2010-2014 and 2015-2019). Baseline demographics, clinical scores, medical co-morbidities, as well as early clinical outcomes were extracted. Categorical and continuous variables were analyzed to determine between-group differences. Sub-group analysis was performed for participants = 50 years of age. Over the duration of the study period, there was an increase in age at presentation (p=0.0077) as well as a greater incidence of falls as the mechanism of injury. Participants who were >=50 years of age were more likely to sustain incomplete SCI (<0.0003) and central cord syndrome (<0.0001). In the most recent time period (2015-2019), a greater proportion of NACTN participants underwent surgery within 24 hours of injury (63% vs 41% vs 41%, p=0.0001). There was a statistically significant increase in cardiac complications (p<0.0001) and decrease in pulmonary complications (p<0.0001) during the study period. Data from the NACTN registry shows that the age of acute SCI participants is increasing, falls have become the major mechanism of injury and central cord injury is becoming increasingly prevalent. While early surgical intervention for acute SCI is more common in recent years, cardiac complications are more prevalent while pulmonary complications are less prevalent.
Journal of Neurotrauma; https://doi.org/10.1089/neu.2022.0259
Traumatic brain injury is a global public health problem associated with chronic neurological complications and long-term disability. Biomarkers that map onto the underlying brain pathology driving these complications are urgently needed to identify individuals at risk for poor recovery and to inform design of clinical trials of neuroprotective therapies. Neuroinflammation and neurodegeneration are two endophenotypes potentially associated with increases in brain extracellular water content, but the nature of extracellular free water abnormalities after neurotrauma and its relationship to measures typically thought to reflect traumatic axonal injury are not well characterized. The objective of this study was to describe the relationship between a neuroimaging biomarker of extracellular free water content and the clinical features of a cohort with primarily complicated mild traumatic brain injury. We analyzed a cohort of 59 adult patients requiring hospitalization for non-penetrating traumatic brain injury of all severities as well as 36 healthy controls. Patients underwent brain MRI at two-weeks (n = 59) and six-months (n = 29) post-injury period, and controls underwent a single MRI. Of the participants with TBI, 50 underwent clinical neuropsychological assessment at two weeks and 28 at six months. For each subject, we derived a summary score representing deviations in whole brain white matter (1) extracellular free water volume fraction (VF) and (2) free water-corrected fractional anisotropy (fw-FA). The summary specific anomaly score (SAS) for VF was significantly higher in TBI patients at two-weeks and six-months post-injury relative to controls. SAS for VF exhibited moderate correlation with neuropsychological functioning, particularly on measures of executive function. These findings indicate abnormalities in whole brain white matter extracellular water fraction in patients with TBI and are an important step toward identifying and validating noninvasive biomarkers that map onto the pathology driving disability after TBI.
Journal of Neurotrauma; https://doi.org/10.1089/neu.2022.0456
The recently published study on external head cooling after concussion in ice hockey players demonstrate a remarkable effect.The scientific basis of the results is, however, ambiguous and the cooling effect of the medical device used has not been properly studied and documented.
Journal of neurotrauma; https://doi.org/10.1089/neu.2022.0068
Low- and middle-income countries (LMICs) experience the majority of traumatic brain injuries (TBIs), yet few studies have examined the epidemiology and management strategies of TBI in LMICs. The objective of this narrative review is to discuss the epidemiology of TBI within LMICs, describe the adherence to Brain Trauma Foundation (BTF) guidelines for the management of severe TBI in LMICs, and document TBI management strategies currently used in LMICs. Papers from January 1, 2009 to September 30, 2021 that included TBI patients greater than 18 years of age in low-, low middle-, and high middle-income countries were queried in PubMed. Search results demonstrated that TBI in LMICs mostly impacts middle-aged males involved in road traffic accidents. Within LMICs there are a myriad of approaches to managing TBI with few randomized controlled trials performed within LMICs to evaluate those interventions. More studies are needed in LMICs to establish the effectiveness and appropriateness of BTF guidelines for managing TBI and to help identify methods for managing TBI that are appropriate in low-resource settings. The larger problem of limited pre- and post-hospital care is a bigger challenge that needs to be considered while addressing management of TBI in LMICs.
Journal of neurotrauma; https://doi.org/10.1089/neu.2022.0227
Traumatic injury is linked increasingly to alterations in both stress response systems and psychological health. We investigated reactivity of salivary analytes of the hypothalamic-pituitary-adrenal axis (cortisol) and autonomic nervous system (salivary alpha amylase, sAA) during a psychosocial stress procedure in relation to psychological health outcomes. In a prospective cohort design, stress reactivity of children ages 8 to 15 years hospitalized for traumatic brain injury (TBI; n=74) or extracranial injury (EI; n=35) was compared with healthy controls (n=51) 7 months after injury. Area under the curve increase (AUCinc) assessed pre-stressor to post-stressor cortisol and sAA values. Multivariable general linear models evaluated demographic, family functioning, group, cortisol and sAA AUCinc, and their interactions in relation to concurrent child and parent ratings of emotion regulation and internalizing and externalizing problems. Although AUCinc values were similar across groups, their relations with outcomes varied by group. Higher stress reactivity is typically associated with fewer adjustment problems. Relative to controls, greater sAA reactivity was associated with greater emotion dysregulation after TBI. In contrast, the relation of sAA reactivity with internalizing and generalized anxiety scores was flatter for both TBI and EI groups.The flattened and/or reversed direction of sAA reactivity with psychological health outcomes after TBI, and to a lesser degree EI, suggests autonomic nervous system dysregulation. Across groups, sAA reactivity interacted with sex on several psychological health outcomes with greater dysregulation in girls than in boys. Our findings highlight altered sAA, but not cortisol reactivity, as a potential mechanism of biological vulnerability associated with poorer adjustment after TBI.
Journal of neurotrauma; https://doi.org/10.1089/neu.2022.0308
Concussions can impact cognitive processes necessary for driving. Young adults, a group who are more likely to engage in risky behaviors, have limited driving experience and a higher rate of motor vehicle collisions; they may be at higher risk for driving impairment after concussion. There are no clear guidelines for return to driving following a concussion. We sought to examine the simulated driving performance of young drivers after receiving medical care following a concussion, compared to a similar control population, to examine the association of driving performance with performance on neuropsychological tests. We evaluated 47 16 to 25 year-old drivers within 3 weeks of sustaining a concussion and 50 drivers with similar characteristics who had not sustained concussions. Participants completed demographic questionnaires, the Sport Concussion Assessment Tool-5 (SCAT-5), and a brief set of neurocognitive tests including the NIH Toolbox Cognition Battery and the Trail Making Test, and a simulated driving assessment. At various times during simulated driving, participants were asked to respond to tactile stimuli using the tactile detection response task (TDRT), a validated method of testing cognitive load during simulated driving. The concussion group reported significantly higher symptoms on the SCAT-5 than the comparison group. Performance on crystallized neurocognitive skills was similar between groups. Performance on fluid neurocognitive skills was significantly lower in the concussion than comparison group, though scores were in the normal range for both groups. Simulated driving was similar between groups, though there was a small but significant difference in variation in speed as well as TDRT miss rate with worse performance by the concussion group. Symptom report on the SCAT-5 was significantly associated with TDRT miss rate. In addition, neurocognitive test scores significantly predicted TDRT reaction time and miss count with medium to large effect sizes. Results suggest that neurocognitive screening may be a useful tool for predicting capacity to return to drive. However, further research is needed to determine guidelines for how neuropsychological tests can be used to make return to driving recommendations and to evaluate effects of concussion on real world driving.
Journal of neurotrauma; https://doi.org/10.1089/neu.2021.0376
Therapies are limited for pediatric traumatic brain injury (TBI), especially for the very young who can experience long term consequences to learning, memory, and social behavior. Animal models of pediatric TBI have yielded mechanistic insights, but demonstration of clinically relevant long-term behavioral and/or cognitive deficits has been challenging. We characterized short- and long-term outcomes in a controlled cortical impact (CCI) model of pediatric TBI using a panel of tests between 2 weeks and ~4 months after injury. Male rats with CCI at postnatal day (PND) 10 were compared with 3 control groups: Naïve, Anesthesia, and Craniotomy. Motor testing (PND25-33), novel object recognition (NOR, PND40-50), and multiple tasks in water maze (WM, PND65-100) were followed by social interaction tests (PND120-140). Anesthesia rats performed the same as Naïve rats in all tasks. TBI rats, when compared to Naïve controls, had functional impairments across most tests studied. The most sensitive cognitive processes affected by TBI included those that required fast one-trial learning (NOR, WM), flexibility of acquired memory traces (reversals in WM), response strategies (WM) or recognition memory in the setting of reciprocal social interactions. Both TBI and Craniotomy groups demonstrated increased rates of decision making across several WM tasks, suggesting disinhibition of motor responses. When the TBI group was compared to the Craniotomy group, however, deficits were detected in a limited number of outcomes. The latter included learning speed (WM), cognitive flexibility (WM) and social recognition memory. Notably, effects of craniotomy, when compared to Naïve controls, spanned across multiple tasks, and, in some tasks, could reach the effect sizes observed in TBI. These results highlight the importance of appropriate control groups in pediatric CCI models. In addition, the study demonstrates the high sensitivity of comprehensive cognitive testing to detect long-term effects of early-age craniotomy and TBI and provides a template for future testing of experimental therapies.
Journal of neurotrauma; https://doi.org/10.1089/neu.2022.0381
This letter to the Editor, is in response to the Narrative Review "Military Traumatic Brain Injury: The History, Impact, and Future. The present investigators have added research contributions from Israeli involvement in Lebanon, Lebanese Civil War and the 8-year Iran Iraq War. Specifically issues such as contamination and infection, traumatic intracranial aneurysms, functional outcome following PBI were added to the extensive narrative review of the world literature by Megan A Lindberg, Elisabeth M Moy Martin and Donald W Marion.
Journal of neurotrauma; https://doi.org/10.1089/neu.2021.0490
Cardiometabolic disease is a leading complication of spinal cord injury (SCI) that contributes to premature all-cause cardiovascular morbidity and early death. Despite widespread reports that cardioendocrine disorders are more prevalent in individuals with SCI than those without disability, a well-defined pathophysiology has not been established. Autonomic dysfunction accompanying disruption of autonomic spinal tracts may contribute to dysregulation of energy metabolism via uncoupling of integrated hunger and satiation signals. In governing human feeding behaviors, these signals are controlled by a network of enteroendocrine cells that line the gastrointestinal (GI) tract. These cells regulate GI peptide release and autonomic systems that maintain direct neuroendocrine communication between the GI tract and appetite circuitry of the hypothalamus and brain stem. Here we investigate gene-expression and physiological changes in GI peptides and hormones, as well as changes in physiological response to feeding, glucose and insulin challenge and evaluate GI tissue cytoarchitecture following experimental SCI. Adult female mice (C57BL/6) were subjected to a severe SCI (65 kDyne) at T9, and a sham control group received laminectomy only. SCI results in chronic elevation of fasting plasma glucose levels, and an exaggerated glucose response after oral glucose and insulin tolerance test. Mice with SCI also exhibit significant alteration in gut hormone genes, plasma levels, physiological response to prandial challenge, and cell loss and gross tissue damage in the gut. These findings demonstrate that SCI has widespread effects on the GI system contributing to component Cardiometabolic disease risks factors and may inform future therapeutic and rehabilitation strategies in humans.
Journal of neurotrauma; https://doi.org/10.1089/neu.2022.0306
Background: Post-acute care after spinal cord injury (SCI) or traumatic brain injury (TBI) influences neurological function regained. Inpatient rehabilitation facilities (IRFs) have more intensive care and result in lower mortality and better functional outcomes compared to skilled nursing facilities (SNFs). This study sought to quantify inpatient rehabilitation access by insurance and estimate the cost implications. Methods: We conducted a retrospective observational cohort study utilizing 2015-2017 California Office of Statewide Health Planning and Development database of injured adults with SCI and/or TBI. The primary predictor was insurance status. The outcome was discharge destination [home, IRFs, SNFs, long-term acute care (LTAC)] modeled using multivariable multinomial mixed-effects logistic regression controlling for age, diagnosis, Weighted Elixhauser Comorbidity Index, and New Injury Severity Score. Cost of care for discharge to IRFs versus SNFs was estimated by adjusted quantile regression. Cost simulation predicted the adjusted cost difference if all publicly insured participants were discharged to an IRF. Results: We identified 83,230 patients with an injury mechanism and a primary acute care hospitalization diagnosis of TBI (90.9%), SCI (8.3%) or both (0.8%) who were discharged to an IRF, SNF, LTAC or home. Publicly insured patients were more likely than privately insured patients to go to SNFs versus IRFs (OR: 2.17, 95%CI [2.01-2.34]). Sub-group analysis of 6,416 participants showed an adjusted median total cost difference of $18,461 (95%CI [$5,908-$38,064]) and adjusted cost-per-day of the post-acute encounter of $1,045 (95%CI [$752-$2,399]) higher for discharge to IRFs versus SNFs. Cost simulation demonstrated an additional adjusted cost of $364M annually for universal IRF access for the publicly insured. Conclusions: Publicly insured SCI and TBI Californians are less frequently discharged to IRFs compared to their privately insured counterparts resulting in a lower short-term cost of care. However, the consequences of decreased intensive rehabilitation utilization in terms of functional recovery and long-term cost implications require further investigation. Abbreviations and Acronyms: SCI, spinal cord injury; TBI, traumatic brain injury; IRF, inpatient rehabilitation facility; SNF, skilled nursing facility; OSHPD, Office of Statewide Health Planning and Development; ICD-9/10-CM, International Classification of Disease, Ninth and Tenth Revisions, Clinical Modifications; LTAC, long-term care facility; NISS, New Injury Severity Score; AHRQ, Agency for Healthcare and Research Quality; ACA, Affordable Care Act