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Blast-induced traumatic brain injury is the most prevalent military injury in Iraq and Afghanistan, yet little is known about the mechanical effects of blasts on the human head, and still less is known about how personal protective equipment affects the brain's response to blasts. In this study we investigated the effect of the Advanced Combat Helmet (ACH) and a conceptual face shield on the propagation of stress waves within the brain tissue following blast events. We used a sophisticated computational framework for simulating coupled fluid--solid dynamic interactions and a three-dimensional biofidelic finite element model of the human head and intracranial contents combined with a detailed model of the ACH and a conceptual face shield. Simulations were conducted in which the unhelmeted head, head with helmet, and head with helmet and face shield were exposed to a frontal blast wave with incident overpressure of 10 atm. Direct transmission of stress waves into the intracranial cavity was observed in the unprotected head and head with helmet simulations. Compared to the unhelmeted head, the head with helmet experienced slight mitigation of intracranial stresses. This suggests that the existing ACH does not significantly contribute to mitigating blast effects, but does not worsen them either. By contrast, the helmet and face shield combination impeded direct transmission of stress waves to the face, resulting in a delay in the transmission of stresses to the intracranial cavity and lower intracranial stresses. This suggests a possible strategy for mitigating blast waves often associated with military concussion. computational models | personal protection equipment doi/ 10.1073/pnas.1014786107

The study aims to evaluate the efficacy of out-of-hospital hypertonic resuscitation in improving neurological outcomes following severe traumatic brain injury (TBI). The results indicate that such form of resuscitation did not result in any improved neurological outcomes in the case of patients with severe TBI.

Byline: Walter Mauritz (1), Heinz Steltzer (2), Peter Bauer (3), Lorenz Dolanski-Aghamanoukjan (3), Philipp Metnitz (4) Keywords: Traumatic brain injury; Intracranial pressure; Mortality; Glasgow Coma Scale; Abbreviated Injury Score Abstract: Objective The goals of this study were to elucidate reasons why patients did or did not receive intracranial pressure (ICP) monitoring and to describe factors influencing hospital mortality after severe traumatic brain injury (TBI). Design Prospective multicenter cohort study. Patients and participants 88,274 patients consecutively admitted to 32 medical, surgical and mixed Austrian ICUs between 1998 and 2004. Interventions None. Measurements and results 1,856 patients (2.1% of all ICU admissions) exhibited severe TBI (GCSa- Conclusions ICP monitoring may possibly have some beneficial effects, but this needs further evaluation. Patients with severe TBI should be admitted to experienced centers with high patient volumes since this might improve hospital mortality rates. Author Affiliation: (1) Department of Anaesthesia and Critical Care Medicine, Trauma Hospital 'Lorenz Boehler', Donaueschingenstrasse 13, 1200, Vienna, Austria (2) Department of Anaesthesia and Critical Care Medicine, Trauma Hospital 'Meidling', Kundratstrasse 37, 1120, Vienna, Austria (3) Department of Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria (4) Department of Anaesthesia and General Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18--20, 1090, Vienna, Austria Article History: Registration Date: 29/02/2008 Received Date: 25/07/2007 Accepted Date: 20/02/2008 Online Date: 26/03/2008 Article note: This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-008-1080-1

OBJECTIVE: To evaluate whether elevated intraoperative blood glucose concentrations are associated with an increased risk of long-term neurologic dysfunction in patients at risk for ischemic brain injury. PATIENTS AND METHODS: Data from 1000 patients were retrieved from the Intraoperative Hypothermia for Aneurysm Surgery Trial database. All patients were recruited between February 2000 and April 2003, and underwent surgery for aneurysm clipping within 14 days of subarachnoid hemorrhage. Gross neurologic and neuropsychological function was evaluated at 3 months after surgery using certified observers and standardized assessment instruments. Intraoperative blood glucose concentrations, measured once when the aneurysm clip was placed, were correlated with neurologic outcome using both univariable and multivariable logistic regression analyses. RESULTS: Blood glucose concentrations at the time of aneurysm clipping ranged from 59 to 331 mg/dL. At 3 months after surgery, those with blood glucose concentrations of 129 mg/dL or more (upper 2 quartiles) were more likely to have impaired cognition (P=.03). Those with glucose concentrations of 152 mg/dL or more (upper quartile) were more likely to experience deficits in gross neurologic function assessed by the National Institutes of Health Stroke Scale (P CONCLUSION: In patients at high risk for ischemic brain injury, intraoperative hyperglycemia, of a magnitude commonly encountered clinically, was associated with long-term changes in cognition and gross neurologic function. Mayo Clin Proc. 2008;83(4):406-417, Both animal models and human case series have demonstrated an association between elevated blood glucose concentration and poor outcome after ischemic brain injury. (1-8) In many of these studies, glucose [...]

Byline: Nino Stocchetti (1), Clelia Zanaboni (1), Angelo Colombo (1), Giuseppe Citerio (2), Luigi Beretta (3), Laura Ghisoni (1), Elisa Roncati Zanier (1), Katia Canavesi (1) Keywords: Intracranial pressure; Surgical decompression; Barbiturates; Hyperventilation; Outcome; Traumatic brain injury Abstract: Objective To quantify the occurrence of high intracranial pressure (HICP) refractory to conventional medical therapy after traumatic brain injury (TBI) and to describe the use of more aggressive therapies (profound hyperventilation, barbiturates, decompressive craniectomy). Design Prospective study of 407 consecutive TBI patients Setting Three neurosurgical intensive care units (ICU). Measurements and results Intracranial pressure (ICP) was studied during the first week after TBI 153 patients had at least 1 day of ICPa->a-20a-mmHg. Early surgery was necessary for 221 cases, and standard medical therapy [sedation, mannitol, cerebrospinal fluid (CSF) withdrawal, PaCO.sub.2 30--35a-mmHg] was used in 135 patients. Reinforced treatment (PaCO.sub.2 25--29a-mmHg, induced arterial hypertension, muscle relaxants) was used in 179 cases (44%), and second-tier therapies in 80 (20%). Surgical decompression and/or barbiturates were used in 28 of 407 cases (7%). Six-month outcome was recorded in 367 cases using the Glasgow outcome scale (GOS). The outcome was favorable (good recovery or moderate disability) in 195 cases (53%) and unfavorable (all the other categories) in 172 (47%). HICP was associated with worse outcome. Outcome for cases who had received second-tier therapies was significantly worse (43% favorable at 6 months, pa-=a-0.03). Conclusions HICP is frequent and is associated with worse outcome. ICP was controlled by early surgery and first-tier therapies in the majority of cases. Profound hyperventilation, surgical decompression and barbiturates were used in various combinations in a minority of cases. The indications for surgical decompression and/or barbiturates seem restricted to less than 10% of severe TBI. Author Affiliation: (1) Neuroscience Intensive Care Unit, Ospedale Maggiore Policlinico, Mangiagalli, e Regina Elena, Fondazione IRCCS, Via F. Sforza 35, 20122, Milan, Italy (2) Terapia Intensiva Neurochirurgica Ospedale S. Gerardo, Monza, Italy (3) Terapia Intensiva Neurochirurgica Ospedale S. Raffaele, Milan, Italy Article History: Registration Date: 15/11/2007 Received Date: 09/03/2007 Accepted Date: 16/10/2007 Online Date: 08/12/2007

This research provides an analysis of the relationship between specific services and employment outcome in RSA consumers with traumatic brain injury (TBI). When assessment, job placement, job search, or diagnosis/treatment were provided, consumers were more likely to obtain employment. Job placement, job search, and diagnosis/treatment also predicted consumers' employment. Only three of these services (i.e., job placement, job search, and diagnosis/treatment) were significantly related to consumers' weekly earnings at case closure. Diagnosis/Treatment was positively related, whereas job placement and job search were negatively related to earnings., It is estimated that 1.5 million Americans sustain a traumatic brain injury (TBI), annually, and that an estimated 5.3 million .individuals live with permanent disabilities as a result of their [...]

Byline: Stefanos Korfias (1,2), George Stranjalis (2), Efstathios Boviatsis (2), Christina Psachoulia (3), Gerard Jullien (3), Barbara Gregson (1), A. David Mendelow (1), Damianos E. Sakas (2) Keywords: S-100B protein; Severe traumatic brain injury; Traumatic brain injury; Outcome Abstract: Objective S-100B protein is a promising marker of injury severity and outcome after head injury. We examined the relationship between serum S-100B concentrations and injury severity, clinical course, survival, and treatment efficacy after severe traumatic brain injury (TBI). Design and setting Prospective observational study in a neurosurgical intensive care unit. Patients and participants 102 adult patients with severe TBI, admitted between June 2001 and November 2003 (30a-months). Interventions Serum S-100B levels were measured by immunoluminometric technique on admission and every 24a-h thereafter for a maximum of 7a-days. Measurements and results Initial S-100B levels were significantly related to pupillary status, computed tomography severity1, and 1-month survival. Cox's proportional hazard regression analysis showed that initial S-100B was an independent predictor of 1-month survival, in the presence of dilated pupils, and with increased age. Subjects with initial levels above 1a-ug/l had a nearly threefold increased probability of death within 1a-month. Serum S-100B alteration indicated neurological improvement or deterioration. Finally, surgical treatment reduced S-100B levels. Conclusions Serum S-100B protein reflects injury severity and improves prediction of outcome after severe TBI. S-100B may also have a role in assessing the efficacy of treatment after severe TBI. Author Affiliation: (1) Department of Neurosurgery, University of Newcastle upon Tyne, Newcastle General Hospital, Westgate Road, NE4 6BE, Newcastle upon Tyne, UK (2) Department of Neurosurgery, University of Athens, Evangelismos General Hospital, 4 Marasli Str., 10676, Athens, Greece (3) Department of Biochemistry, Evangelismos General Hospital, 4 Marasli Str., 10676, Athens, Greece Article History: Registration Date: 24/10/2006 Received Date: 03/04/2006 Accepted Date: 23/10/2006 Online Date: 02/12/2006