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1. Vibrational spectroscopy for the triage of traumatic brain injury computed tomography priority and hospital admissions

Author

Theakstone, AG, Brennan, PM, Ashton, K, Czeiter, E, Jenkinson, MD, Syed, K, Reed, MJ, Baker, MJ, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Clusmann, H, Coburn, M, Coles, J, Cooper, JD, Correia, M, Amra Čović, A, Curry, N, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, Keyser, VD, Degos, V, Corte, FD, Boogert, HD, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, G-L, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, RL, Gupta, D, Haagsma, JA, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J-Y, Johnson, F, Jones, K, Karan, M, Kolias, AG, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, L-O, Kovács, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, AIR, Castaño-León, AM, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, J-F, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, IR, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Singh, RD, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, EW, Stocchetti, N, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Taylor, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Jagt, MVD, Steen, GVD, Naalt, JVD, van Dijck, JTJM, van Erp, IA, van Essen, TA, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, Vyvere, TV, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, Steinbüchel, NV, Voormolen, D, Vulekovic, P, Wang, KKW, Whitehouse, D, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, and Zoerle, T

Abstract

Computed tomography (CT) brain imaging is routinely used to support clinical decision-making in patients with traumatic brain injury (TBI). Only 7% of scans, however, demonstrate evidence of TBI. The other 93% of scans contribute a significant cost to the healthcare system and a radiation risk to patients. There may be better strategies to identify which patients, particularly those with mild TBI, are at risk of deterioration and require hospital admission. We introduce a blood serum liquid biopsy that utilizes attenuated total reflectance (ATR)-Fourier transform infrared (FTIR) spectroscopy with machine learning algorithms as a decision-making tool to identify which patients with mild TBI will most likely present with a positive CT scan. Serum samples were obtained from patients (n = 298) patients who had acquired a TBI and were enrolled in CENTER-TBI and from asymptomatic control patients (n = 87). Injury patients (all severities) were stratified against non-injury controls. The cohort with mild TBI was further examined by stratifying those who had at least one CT abnormality against those who had no CT abnormalities. The test performed exceptionally well in classifications of patients with mild injury versus non-injury controls (sensitivity = 96.4% and specificity = 98.0%) and also provided a sensitivity of 80.2% when stratifying mild patients with at least one CT abnormality against those without. The results provided illustrate the test ability to identify four of every five CT abnormalities and show great promise to be introduced as a triage tool for CT priority in patients with mild TBI.

Published
2022

6. Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients : a CENTER-TBI study

Author

van Veen, E, van der Jagt, M, Citerio, G, Stocchetti, N, Gommers, D, Burdorf, A, Menon, DK, Maas, AIR, Kompanje, EJO, Lingsma, HF, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Clusmann, H, Coburn, M, Coles, J, Cooper, JD, Correia, M, Čović, A, Curry, N, Czeiter, E, Czosnyka, M, Fizelier, CD, Dark, P, Dawes, H, De Keyser, V, Degos, V, Corte, FD, den Boogert, H, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, GL, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, RL, Gupta, D, Haagsma, JA, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, JY, Johnson, F, Jones, K, Karan, M, Kolias, AG, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, LO, Kovács, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Castaño, AML, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, JF, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, IR, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Porras, RS, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, EW, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Taylo, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van der Naalt, J, van Dijck, JTJM, van Essen, TA, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, TV, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, von Steinbüchel, N, Voormolen, D, Vulekovic, P, Wang, KKW, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, Zoerle, T, van Veen, Ernest [0000-0002-5495-3996], and Apollo - University of Cambridge Repository

Subjects
Critical care, Traumatic brain injury, WLSM, Original, Intensive care unit
Abstract

Background\ud \ud In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI).\ud \ud \ud \ud Methods\ud \ud The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (

Published
2021

8. Head injury

Author

Johnson, RD, primary, Zhou, F, additional, Santarius, T, additional, Wilberger, JE, additional, and Rosenfeld, JV, additional

Published
2014
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9. Incidence, Risk Factors, and Effects on Outcome of Ventilator-Associated Pneumonia in Patients With Traumatic Brain Injury: Analysis of a Large, Multicenter, Prospective, Observational Longitudinal Study

Author

Robba, C, Rebora, P, Banzato, E, Wiegers, Eveline, Stocchetti, N, Menon, DK, Citerio, G, Åkerlund, C, Nelson, D, Amrein, K, Nyirádi, J, Andelic, N, Andreassen, L, Anke, A, Audibert, G, Azouvi, P, Azzolini, ML, Beretta, L, Calvi, MR, Bartels, R, Boogert, HD, Roelofsen-de Beer, R, Helbok, R, Bellander, BM, Benali, H, Degos, V, Galanaud, D, Perlbarg, V, Vanhaudenhuyse, A, Berardino, M, Blaabjerg, M, Lund, SB, Brorsson, C, Buki, A, Czeiter, E, Cabeleira, M, Czosnyka, M, Smielewski, P, Caccioppola, A, Calappi, E, Carbonara, M, Mulazzi, D, Ortolano, F, Zoerle, T, Cameron, P, Gantner, D, Murray, L, Trapani, T, Vallance, S, Lozano, GC, Pomposo, I, Castaño-León, AM, Gomez, PA, Lagares, A, Chevallard, G, Chieregato, A, Coburn, M, Kowark, A, Rossaint, R, Coles, J, Cooper, JD, Correia, M, Dahyot-Fizelier, C, De Keyser, V, Maas, AIR (Arne), Menovsky, T, Nair, N, Van der Steen, G, Della Corte, F, Grossi, F, Depreitere, B, Dilvesi, D, Golubovic, J, Karan, M, Vulekovic, P, Dixit, A, Ercole, A, Koraropoulos, E, Menon, D, Newcombe, V, Richter, S, Stamatakis, E, Williams, G, Winzeck, S, Zeiler, FA, Dreier, J, Dulière, GL, Maréchal, H, Ezer, E, Vámos, Z, Fabricius, M, Kondziella, D, Foks, K, Frisvold, S, Furmanov, A, Rosenthal, G, Ghuysen, A, Giga, L, Valeinis, E, Ziverte, A, Gupta, D, Haitsma, I, Volovici, Victor, Helseth, E, Hutchinson, P J, Kolias, AG, Jankowski, S, Koskinen, LO, Kovács, N, Laureys, S, Noirhomme, Q, Lejeune, A, Vega, E, Lightfoot, R, Steyerberg, Ewout, Lingsma, Hester, Voormolen, Daphne, Manara, A, Thomas, M, Martino, C, Mattern, J, Sakowitz, O, Younsi, A, McMahon, C, Muraleedharan, V, Negru, A, Ples, H, Tudora, CM, Payen, JF, Persona, P, Rossi, S, Peul, W, van Dijck, JTMJ, Essen, TA, van Wijk, RPJ, Piippo-Karjalainen, A, Raj, R, Posti, J P, Tenovuo, O, Puybasset, L, Radoi, A, Sahuquillo, J, Ragauskas, A, Rocka, S, Rhodes, J, Roe, C, Roise, O, Rosenfeld, JV, Rosenlund, C, Sandro, O, Schirmer-Mikalsen, K, Sanchez-Porras, R, Vik, A, Schou, RF, Sorinola, A, Tamás, V, Sundström, N, Takala, R, Tamosuitis, T, Tibboel, Dick, Tolias, C, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Public Health, Neurosurgery, and Pediatric Surgery

Published
2020

10. Health-related quality of life after traumatic brain injury : deriving value sets for the QOLIBRI-OS for Italy, The Netherlands and The United Kingdom

Author

Voormolen, DC, Polinder, S, von Steinbuechel, N, Feng, Y, Wilson, L, Oppe, M, Haagsma, JA, Åkerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Castaño-León, AM, Chevallard, G, Chieregato, A, Citerio, G, Cnossen, M, Coburn, M, Coles, J, Cooper, JD, Correia, M, Čović, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dawes, H, De Keyser, V, Degos, V, Corte, FD, Boogert, HD, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, G-L, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, L.Gruen, R, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J-Y, Jones, K, Karan–, M, Kolias, AG, Kompanje, E, Kondziella, D, Koskinen, L-O, Kovács, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, AIR, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McFadyen, C, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, J-F, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevanovic, A, Stevens, R, Stewart, W, Steyerberg, EW, Stocchetti, N, Sundström, N, Synnot, A, Takala, R, Tamás, V, Tamosuitis, T, Taylor, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van der Naalt, J, van Dijck, JTJM, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, TV, Vanhaudenhuyse, A, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, von Steinbüchel, N, Voormolen, D, Vulekovic, P, Wang, KKW, Wiegers, E, Williams, G, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, Zoerle, T, Voormolen, D. C., Polinder, S., von Steinbuechel, N., Feng, Y., Wilson, L., Oppe, M., Haagsma, J. A., Akerlund, C., Adams, H., Amrein, K., Andelic, N., Andreassen, L., Anke, A., Antoni, A., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Barzo, P., Beauvais, R., Beer, R., Bellander, B. -M., Belli, A., Benali, H., Berardino, M., Beretta, L., Blaabjerg, M., Bragge, P., Brazinova, A., Brinck, V., Brooker, J., Brorsson, C., Buki, A., Bullinger, M., Cabeleira, M., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Carbonara, M., Castano-Leon, A. M., Chevallard, G., Chieregato, A., Citerio, G., Cnossen, M., Coburn, M., Coles, J., Cooper, J. D., Correia, M., Covic, A., Curry, N., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Dawes, H., De Keyser, V., Degos, V., Corte, F. D., Boogert, H., Depreitere, B., Dilvesi, D., Dixit, A., Donoghue, E., Dreier, J., Duliere, G. -L., Ercole, A., Esser, P., Ezer, E., Fabricius, M., Feigin, V. L., Foks, K., Frisvold, S., Furmanov, A., Gagliardo, P., Galanaud, D., Gantner, D., Gao, G., George, P., Ghuysen, A., Giga, L., Glocker, B., Golubovic, J., Gomez, P. A., Gratz, J., Gravesteijn, B., Grossi, F., L. Gruen, R., Gupta, D., Haitsma, I., Helbok, R., Helseth, E., Horton, L., Huijben, J., Hutchinson, P. J., Jacobs, B., Jankowski, S., Jarrett, M., Jiang, J. -Y., Jones, K., Karan-, M., Kolias, A. G., Kompanje, E., Kondziella, D., Koskinen, L. -O., Kovacs, N., Lagares, A., Lanyon, L., Laureys, S., Lecky, F., Lefering, R., Legrand, V., Lejeune, A., Levi, L., Lightfoot, R., Lingsma, H., Maas, A. I. R., Maegele, M., Majdan, M., Manara, A., Manley, G., Martino, C., Marechal, H., Mattern, J., Mcfadyen, C., Mcmahon, C., Melegh, B., Menon, D., Menovsky, T., Mulazzi, D., Muraleedharan, V., Murray, L., Nair, N., Negru, A., Nelson, D., Newcombe, V., Nieboer, D., Noirhomme, Q., Nyiradi, J., Olubukola, O., Oresic, M., Ortolano, F., Palotie, A., Parizel, P. M., Payen, J. -F., Perera, N., Perlbarg, V., Persona, P., Peul, W., Piippo-Karjalainen, A., Pirinen, M., Ples, H., Pomposo, I., Posti, J. P., Puybasset, L., Radoi, A., Ragauskas, A., Raj, R., Rambadagalla, M., Real, R., Rhodes, J., Richardson, S., Richter, S., Ripatti, S., Rocka, S., Roe, C., Roise, O., Rosand, J., Rosenfeld, J. V., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Rueckert, D., Rusnak, M., Sahuquillo, J., Sakowitz, O., Sanchez-Porras, R., Sandor, J., Schafer, N., Schmidt, S., Schoechl, H., Schoonman, G., Schou, R. F., Schwendenwein, E., Sewalt, C., Skandsen, T., Smielewski, P., Sorinola, A., Stamatakis, E., Stanworth, S., Stevanovic, A., Stevens, R., Stewart, W., Steyerberg, E. W., Stocchetti, N., Sundstrom, N., Synnot, A., Takala, R., Tamas, V., Tamosuitis, T., Taylor, M. S., Ao, B. T., Tenovuo, O., Theadom, A., Thomas, M., Tibboel, D., Timmers, M., Tolias, C., Trapani, T., Tudora, C. M., Vajkoczy, P., Vallance, S., Valeinis, E., Vamos, Z., Van der Steen, G., van der Naalt, J., van Dijck, J. T. J. M., van Essen, T., Van Hecke, W., van Heugten, C., Van Praag, D., Vyvere, T. V., Vanhaudenhuyse, A., van Wijk, R. P. J., Vargiolu, A., Vega, E., Velt, K., Verheyden, J., Vespa, P. M., Vik, A., Vilcinis, R., Volovici, V., von Steinbuchel, N., Voormolen, D., Vulekovic, P., Wang, K. K. W., Wiegers, E., Williams, G., Wolf, S., Yang, Z., Ylen, P., Younsi, A., Zeiler, F. A., Zelinkova, V., Ziverte, A., Zoerle, T., Centre of Excellence in Complex Disease Genetics, Research Programs Unit, Aarno Palotie / Principal Investigator, Institute for Molecular Medicine Finland, Genomics of Neurological and Neuropsychiatric Disorders, HUS Neurocenter, Neurokirurgian yksikkö, Helsinki Institute for Information Technology, Statistical and population genetics, Department of Mathematics and Statistics, Biostatistics Helsinki, Clinicum, Helsinki University Hospital Area, Department of Public Health, Samuli Olli Ripatti / Principal Investigator, Complex Disease Genetics, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Psychiatrie & Neuropsychologie, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Molecular Neuroscience and Ageing Research (MOLAR), Public Health, Voormolen, Daphne C [0000-0003-0449-0708], Apollo - University of Cambridge Repository, Voormolen, D, Polinder, S, von Steinbuechel, N, Feng, Y, Wilson, L, Oppe, M, Haagsma, J, Akerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Carbonara, M, Castano-Leon, A, Chevallard, G, Chieregato, A, Citerio, G, Cnossen, M, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dawes, H, De Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, L. Gruen, R, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Jones, K, Karan-, M, Kolias, A, Kompanje, E, Kondziella, D, Koskinen, L, Kovacs, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcfadyen, C, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevanovic, A, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Synnot, A, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, Van der Steen, G, van der Naalt, J, van Dijck, J, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, T, Vanhaudenhuyse, A, van Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, and Zoerle, T

Subjects
Male, CONJOINT-ANALYSIS, Neurologi, VALUATION, Health-related quality of life, Discrete choice experiment, 0302 clinical medicine, Traumatic brain injury, Surveys and Questionnaires, Brain Injuries, Traumatic, SCALE, media_common, Netherlands, 030503 health policy & services, Health utilities, Health-related quality of life, Quality of life after brain injury overall scale (QOLIBRI-OS), Traumatic brain injury, Value set, Art, Middle Aged, STATE, 3142 Public health care science, environmental and occupational health, 3. Good health, Neurology, Italy, Female, 0305 other medical science, Quality of life after brain injury overall scale (QOLIBRI-OS), Adult, Value set, Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, DISCRETE-CHOICE EXPERIMENTS, Adolescent, media_common.quotation_subject, Article, 03 medical and health sciences, Kingdom, Young Adult, SDG 3 - Good Health and Well-being, Inigo, Humans, Quality of Life Research, Aged, Health related quality of life, Public Health, Environmental and Occupational Health, Health Care Service and Management, Health Policy and Services and Health Economy, EUROQOL, United Kingdom, 3141 Health care science, health utilities, health-related quality of life, quality of life after brain injury overall scale (QOLIBRI-OS), traumatic brain injury, value set, Health utilities, PREFERENCE-BASED MEASURES, Quality of Life, Humanities, 030217 neurology & neurosurgery
Abstract

PURPOSE: The Quality of Life after Brain Injury overall scale (QOLIBRI-OS) measures health-related quality of life (HRQoL) after traumatic brain injury (TBI). The aim of this study was to derive value sets for the QOLIBRI-OS in three European countries, which will allow calculation of utility scores for TBI health states. METHODS: A QOLIBRI-OS value set was derived by using discrete choice experiments (DCEs) and visual analogue scales (VAS) in general population samples from the Netherlands, United Kingdom and Italy. A three-stage procedure was used: (1) A selection of health states, covering the entire spectrum of severity, was defined; (2) General population samples performed the health state valuation task using a web-based survey with three VAS questions and an at random selection of sixteen DCEs; (3) DCEs were analysed using a conditional logistic regression and were then anchored on the VAS data. Utility scores for QOLIBRI-OS health states were generated resulting in estimates for all potential health states. RESULTS: The questionnaire was completed by 13,623 respondents. The biggest weight increase for all attributes is seen from "slightly" to "not at all satisfied", resulting in the largest impact on HRQoL. "Not at all satisfied with how brain is working" should receive the greatest weight in utility calculations in all three countries. CONCLUSION: By transforming the QOLIBRI-OS into utility scores, we enabled the application in economic evaluations and in summary measures of population health, which may be used to inform decision-makers on the best interventions and strategies for TBI patients., Hannelore Kohl Stiftung (Germany) OneMind (USA) Integra LifeSciences Corporation (USA)

Published
2020

11. Patient Outcomes at Twelve Months after Early Decompressive Craniectomy for Diffuse Traumatic Brain Injury in the Randomized DECRA Clinical Trial

Author

Cooper, DJ, Rosenfeld, JV, Murray, L, Arabi, YM, Davies, AR, Ponsford, J, Seppelt, I, Reilly, P, Wiegers, E, Wolfe, R, Cooper, DJ, Rosenfeld, JV, Murray, L, Arabi, YM, Davies, AR, Ponsford, J, Seppelt, I, Reilly, P, Wiegers, E, and Wolfe, R

Abstract

Functional outcomes at 12 months were a secondary outcome of the randomized DECRA trial of early decompressive craniectomy for severe diffuse traumatic brain injury (TBI) and refractory intracranial hypertension. In the DECRA trial, patients were randomly allocated 1:1 to either early decompressive craniectomy or intensive medical therapies (standard care). We conducted planned secondary analyses of the DECRA trial outcomes at 6 and 12 months, including all 155 patients. We measured functional outcome using the Glasgow Outcome Scale-Extended (GOS-E). We used ordered logistic regression, and dichotomized the GOS-E using logistic regression, to assess outcomes in patients overall and in survivors. We adjusted analyses for injury severity using the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) model. At 12 months, the odds ratio (OR) for worse functional outcomes in the craniectomy group (OR 1.68; 95% confidence interval [CI]: 0.96-2.93; p = 0.07) was no longer significant. Unfavorable functional outcomes after craniectomy were 11% higher (59% compared with 48%), but were not significantly different from standard care (OR 1.58; 95% CI: 0.84-2.99; p = 0.16). Among survivors after craniectomy, there were fewer good (OR 0.33; 95% CI: 0.12-0.91; p = 0.03) and more vegetative (OR 5.12; 95% CI: 1.04-25.2; p = 0.04) outcomes. Similar outcomes in survivors were found at 6 months after injury. Vegetative (OR 5.85; 95% CI: 1.21-28.30; p = 0.03) and severely disabled outcomes (OR 2.49; 95% CI: 1.21-5.11; p = 0.01) were increased. Twelve months after severe diffuse TBI and early refractory intracranial hypertension, decompressive craniectomy did not improve outcomes and increased vegetative survivors.

Published
2020

14. Evaluation of a targeted, theory-informed implementation intervention designed to increase uptake of emergency management recommendations regarding adult patients with mild traumatic brain injury: results of the NET cluster randomised trial

Author

Bosch, M, McKenzie, JE, Ponsford, JL, Turner, S, Chau, M, Tavender, EJ, Knott, JC, Gruen, RL, Francis, JJ, Brennan, SE, Pearce, A, O'Connor, DA, Mortimer, D, Grimshaw, JM, Rosenfeld, JV, Meares, S, Smyth, T, Michie, S, Green, SE, Bosch, M, McKenzie, JE, Ponsford, JL, Turner, S, Chau, M, Tavender, EJ, Knott, JC, Gruen, RL, Francis, JJ, Brennan, SE, Pearce, A, O'Connor, DA, Mortimer, D, Grimshaw, JM, Rosenfeld, JV, Meares, S, Smyth, T, Michie, S, and Green, SE

Abstract

BACKGROUND: Evidence-based guidelines for management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available; however, clinical practice remains inconsistent with these guidelines. A targeted, theory-informed implementation intervention (Neurotrauma Evidence Translation (NET) intervention) was designed to increase the uptake of three clinical practice recommendations regarding the management of patients who present to Australian EDs with mild head injuries. The intervention involved local stakeholder meetings, identification and training of nursing and medical local opinion leaders, train-the-trainer workshops and standardised education materials and interactive workshops delivered by the opinion leaders to others within their EDs during a 3 month period. This paper reports on the effects of this intervention. METHODS: EDs (clusters) were allocated to receive either access to a clinical practice guideline (control) or the implementation intervention, using minimisation, a method that allocates clusters to groups using an algorithm to minimise differences in predefined factors between the groups. We measured clinical practice outcomes at the patient level using chart audit. The primary outcome was appropriate screening for post-traumatic amnesia (PTA) using a validated tool until a perfect score was achieved (indicating absence of acute cognitive impairment) before the patient was discharged home. Secondary outcomes included appropriate CT scanning and the provision of written patient information upon discharge. Patient health outcomes (anxiety, primary outcome: Hospital Anxiety and Depression Scale) were also assessed using follow-up telephone interviews. Outcomes were assessed by independent auditors and interviewers, blinded to group allocation. RESULTS: Fourteen EDs were allocated to the intervention and 17 to the control condition; 1943 patients were included in the chart audit. At 2 months follow-up, patients attending in

Published
2019

17. Statistical analysis plan for the POLAR-RCT: The Prophylactic hypOthermia trial to Lessen trAumatic bRain injury-Randomised Controlled Trial

Author

Presneill, J, Gantner, D, Nichol, A, McArthur, C, Forbes, A, Kasza, J, Trapani, T, Murray, L, Bernard, S, Cameron, P, Capellier, G, Huet, O, Newby, L, Rashford, S, Rosenfeld, JV, Smith, T, Stephenson, M, Varma, D, Vallance, S, Walker, T, Webb, S, Cooper, DJ, Presneill, J, Gantner, D, Nichol, A, McArthur, C, Forbes, A, Kasza, J, Trapani, T, Murray, L, Bernard, S, Cameron, P, Capellier, G, Huet, O, Newby, L, Rashford, S, Rosenfeld, JV, Smith, T, Stephenson, M, Varma, D, Vallance, S, Walker, T, Webb, S, and Cooper, DJ

Abstract

BACKGROUND: The Prophylactic hypOthermia to Lessen trAumatic bRain injury-Randomised Controlled Trial (POLAR-RCT) will evaluate whether early and sustained prophylactic hypothermia delivered to patients with severe traumatic brain injury improves patient-centred outcomes. METHODS: The POLAR-RCT is a multicentre, randomised, parallel group, phase III trial of early, prophylactic cooling in critically ill patients with severe traumatic brain injury, conducted in Australia, New Zealand, France, Switzerland, Saudi Arabia and Qatar. A total of 511 patients aged 18-60 years have been enrolled with severe acute traumatic brain injury. The trial intervention of early and sustained prophylactic hypothermia to 33 °C for 72 h will be compared to standard normothermia maintained at a core temperature of 37 °C. The primary outcome is the proportion of favourable neurological outcomes, comprising good recovery or moderate disability, observed at six months following randomisation utilising a midpoint dichotomisation of the Extended Glasgow Outcome Scale (GOSE). Secondary outcomes, also assessed at six months following randomisation, include the probability of an equal or greater GOSE level, mortality, the proportions of patients with haemorrhage or infection, as well as assessment of quality of life and health economic outcomes. The planned sample size will allow 80% power to detect a 30% relative risk increase from 50% to 65% (equivalent to a 15% absolute risk increase) in favourable neurological outcome at a two-sided alpha of 0.05. DISCUSSION: Consistent with international guidelines, a detailed and prospective analysis plan has been developed for the POLAR-RCT. This plan specifies the statistical models for evaluation of primary and secondary outcomes, as well as defining covariates for adjusted analyses and methods for exploratory analyses. Application of this statistical analysis plan to the forthcoming POLAR-RCT trial will facilitate unbiased analyses of these important cl

Published
2018

18. Advances in implantable bionic devices for blindness: a review

Author

Lewis, PM, Ayton, LN, Guymer, RH, Lowery, AJ, Blamey, PJ, Allen, PJ, Luu, CD, Rosenfeld, JV, Lewis, PM, Ayton, LN, Guymer, RH, Lowery, AJ, Blamey, PJ, Allen, PJ, Luu, CD, and Rosenfeld, JV

Abstract

Since the 1950s, vision researchers have been working towards the ambitious goal of restoring a functional level of vision to the blind via electrical stimulation of the visual pathways. Groups based in Australia, USA, Germany, France and Japan report progress in the translation of retinal visual prosthetics from the experimental to clinical domains, with two retinal visual prostheses having recently received regulatory approval for clinical use. Regulatory approval for cortical visual prostheses is yet to be obtained; however, several groups report plans to conduct clinical trials in the near future, building upon the seminal clinical studies of Brindley and Dobelle. In this review, we discuss the general principles of visual prostheses employing electrical stimulation of the visual pathways, focusing on the retina and visual cortex as the two most extensively studied stimulation sites. We also discuss the surgical and functional outcomes reported to date for retinal and cortical prostheses, concluding with a brief discussion of novel developments in this field and an outlook for the future.

Published
2016

19. Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery.

Author

Battistuzzo, CR, Armstrong, A, Clark, J, Worley, L, Sharwood, L, Lin, P, Rooke, G, Skeers, P, Nolan, S, Geraghty, T, Nunn, A, Brown, DJ, Hill, S, Alexander, J, Millard, M, Cox, SF, Rao, S, Watts, A, Goods, L, Allison, GT, Agostinello, J, Cameron, PA, Mosley, I, Liew, SM, Geddes, T, Middleton, J, Buchanan, J, Rosenfeld, JV, Bernard, S, Atresh, S, Patel, A, Schouten, R, Freeman, BJC, Dunlop, SA, Batchelor, PE, Battistuzzo, CR, Armstrong, A, Clark, J, Worley, L, Sharwood, L, Lin, P, Rooke, G, Skeers, P, Nolan, S, Geraghty, T, Nunn, A, Brown, DJ, Hill, S, Alexander, J, Millard, M, Cox, SF, Rao, S, Watts, A, Goods, L, Allison, GT, Agostinello, J, Cameron, PA, Mosley, I, Liew, SM, Geddes, T, Middleton, J, Buchanan, J, Rosenfeld, JV, Bernard, S, Atresh, S, Patel, A, Schouten, R, Freeman, BJC, Dunlop, SA, and Batchelor, PE

Abstract

Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times associated with closed reduction (6 h). A significant decrease in the time to decompression occurred from 2010 (31 h) to 2013 (19 h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression, compared with patients undergoing pre-surgical hospital admission (12 h vs. 26 h, p < 0.0001). Medical stabilization and radiological investigation appeared not to influence the timing of surgery. The time taken to organize the operating theater following surgical hospital admission was a further factor delaying decompression (12.5 h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 American Spinal Injury Association Impairment Scale grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organization of theater, and where possible, use of closed reduction, are likely to be effective strategies to reduce the time to decompression.

Published
2016

20. Activation of the kynurenine pathway and increased production of the excitotoxin quinolinic acid following traumatic brain injury in humans

Author

Yan, EB, Frugier, T, Lim, CK, Heng, B, Sundaram, G, Tan, M, Rosenfeld, JV, Walker, DW, Guillemin, GJ, Morganti-Kossmann, MC, Yan, EB, Frugier, T, Lim, CK, Heng, B, Sundaram, G, Tan, M, Rosenfeld, JV, Walker, DW, Guillemin, GJ, and Morganti-Kossmann, MC

Abstract

During inflammation, the kynurenine pathway (KP) metabolises the essential amino acid tryptophan (TRP) potentially contributing to excitotoxicity via the release of quinolinic acid (QUIN) and 3-hydroxykynurenine (3HK). Despite the importance of excitotoxicity in the development of secondary brain damage, investigations on the KP in TBI are scarce. In this study, we comprehensively characterised changes in KP activation by measuring numerous metabolites in cerebrospinal fluid (CSF) from TBI patients and assessing the expression of key KP enzymes in brain tissue from TBI victims. Acute QUIN levels were further correlated with outcome scores to explore its prognostic value in TBI recovery. Methods: Twenty-eight patients with severe TBI (GCS ≤ 8, three patients had initial GCS = 9-10, but rapidly deteriorated to ≤8) were recruited. CSF was collected from admission to day 5 post-injury. TRP, kynurenine (KYN), kynurenic acid (KYNA), QUIN, anthranilic acid (AA) and 3-hydroxyanthranilic acid (3HAA) were measured in CSF. The Glasgow Outcome Scale Extended (GOSE) score was assessed at 6 months post-TBI. Post-mortem brains were obtained from the Australian Neurotrauma Tissue and Fluid Bank and used in qPCR for quantitating expression of KP enzymes (indoleamine 2,3-dioxygenase-1 (IDO1), kynurenase (KYNase), kynurenine amino transferase-II (KAT-II), kynurenine 3-monooxygenase (KMO), 3-hydroxyanthranilic acid oxygenase (3HAO) and quinolinic acid phosphoribosyl transferase (QPRTase) and IDO1 immunohistochemistry. Results: In CSF, KYN, KYNA and QUIN were elevated whereas TRP, AA and 3HAA remained unchanged. The ratios of QUIN:KYN, QUIN:KYNA, KYNA:KYN and 3HAA:AA revealed that QUIN levels were significantly higher than KYN and KYNA, supporting increased neurotoxicity. Amplified IDO1 and KYNase mRNA expression was demonstrated on post-mortem brains, and enhanced IDO1 protein coincided with overt tissue damage. QUIN levels in CSF were significantly higher in patients with unfavourable

Published
2015

21. Could low grade bacterial infection contribute to low back pain? A systematic review

Author

Urquhart, DM, Zheng, Y, Cheng, AC, Rosenfeld, JV, Chan, P, Liew, S, Hussain, SM, Cicuttini, FM, Urquhart, DM, Zheng, Y, Cheng, AC, Rosenfeld, JV, Chan, P, Liew, S, Hussain, SM, and Cicuttini, FM

Abstract

BACKGROUND: Recently, there has been both immense interest and controversy regarding a randomised, controlled trial which showed antibiotics to be effective in the treatment of chronic low back pain (disc herniation with Modic Type 1 change). While this research has the potential to result in a paradigm shift in the treatment of low back pain, several questions remain unanswered. This systematic review aims to address these questions by examining the role of bacteria in low back pain and the relationship between bacteria and Modic change. METHODS: We conducted electronic searches of MEDLINE and EMBASE and included studies that examined the relationship between bacteria and back pain or Modic change. Studies were rated based on their methodological quality, a best-evidence synthesis was used to summarise the results, and Bradford Hill's criteria were used to assess the evidence for causation. RESULTS: Eleven studies were identified. The median (range) age and percentage of female participants was 44.7 (41-46.4) years and 41.5% (27-59%), respectively, and in 7 of the 11 studies participants were diagnosed with disc herniation. Nine studies examined the presence of bacteria in spinal disc material and all identified bacteria, with the pooled estimate of the proportion with positive samples being 34%. Propionibacterium acnes was the most prevalent bacteria, being present in 7 of the 9 studies, with median (minimum, maximum) 45.0% (0-86.0) of samples positive. The best evidence synthesis found moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change with disc herniation. There was modest evidence for a cause-effect relationship. CONCLUSIONS: We found that bacteria were common in the spinal disc material of people undergoing spinal surgery. There was moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change associ

Published
2015

22. Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial

Author

Bosch, M, McKenzie, JE, Mortimer, D, Tavender, EJ, Francis, JJ, Brennan, SE, Knott, JC, Ponsford, JL, Pearce, A, O'Connor, DA, Grimshaw, JM, Rosenfeld, JV, Gruen, RL, Green, SE, Bosch, M, McKenzie, JE, Mortimer, D, Tavender, EJ, Francis, JJ, Brennan, SE, Knott, JC, Ponsford, JL, Pearce, A, O'Connor, DA, Grimshaw, JM, Rosenfeld, JV, Gruen, RL, and Green, SE

Abstract

BACKGROUND: Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. METHODS/DESIGN: The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following interven

Published
2014

23. Measurement of serum melatonin in intensive care unit patients: changes in traumatic brain injury, trauma, and medical conditions

Author

Seifman, MA, Gomes, K, Nguyen, PN, Bailey, M, Rosenfeld, JV, Cooper, DJ, Morganti-Kossmann, MC, Seifman, MA, Gomes, K, Nguyen, PN, Bailey, M, Rosenfeld, JV, Cooper, DJ, and Morganti-Kossmann, MC

Abstract

Melatonin is an endogenous hormone mainly produced by the pineal gland whose dysfunction leads to abnormal sleeping patterns. Changes in melatonin have been reported in acute traumatic brain injury (TBI); however, the impact of environmental conditions typical of the intensive care unit (ICU) has not been assessed. The aim of this study was to compare daily melatonin production in three patient populations treated at the ICU to differentiate the role of TBI versus ICU conditions. Forty-five patients were recruited and divided into severe TBI, trauma without TBI, medical conditions without trauma, and compared to healthy volunteers. Serum melatonin levels were measured at four daily intervals at 0400 h, 1000 h, 1600 h, and 2200 h for 7 days post-ICU admission by commercial enzyme linked immunosorbent assay. The geometric mean concentrations (95% confidence intervals) of melatonin in these groups showed no difference being 8.3 (6.3-11.0), 9.3 (7.0-12.3), and 8.9 (6.6-11.9) pg/mL, respectively, in TBI, trauma, and intensive care cohorts. All of these patient groups demonstrated decreased melatonin concentrations when compared to control patients. This study suggests that TBI as well as ICU conditions, may have a role in the dysfunction of melatonin. Monitoring and possibly substituting melatonin acutely in these settings may assist in ameliorating long-term sleep dysfunction in all of these groups, and possibly contribute to reducing secondary brain injury in severe TBI.

Published
2014

24. Improving the care of people with traumatic brain injury through the Neurotrauma Evidence Translation (NET) program: protocol for a program of research

Author

Green, SE, Bosch, M, McKenzie, JE, O'Connor, DA, Tavender, EJ, Bragge, P, Chau, M, Pitt, V, Rosenfeld, JV, Gruen, RL, Green, SE, Bosch, M, McKenzie, JE, O'Connor, DA, Tavender, EJ, Bragge, P, Chau, M, Pitt, V, Rosenfeld, JV, and Gruen, RL

Abstract

The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research program. The overarching aims of the program are threefold: to improve outcomes for people with traumatic brain injury; to create a network of neurotrauma clinicians and researchers with expertise in knowledge translation and evidence-based practice; and to contribute knowledge to the field of knowledge translation research. The program comprises a series of interlinked projects spanning varying clinical environments and disciplines relevant to neurotrauma, anchored within four themes representing core knowledge translation activities: reviewing research evidence; understanding practice; developing and testing interventions for practice change; and building capacity for knowledge translation in neurotrauma. The program uses a range of different methods and study designs, including: an evidence fellowship program; conduct of and training in systematic reviews; mixed method study designs to describe and understand factors that influence current practices (e.g., semi-structured interviews and surveys); theory-based methods to develop targeted interventions aiming to change practice; a cluster randomised trial to test the effectiveness of a targeted theory-informed intervention; stakeholder involvement activities; and knowledge translation events such as consensus conferences.

Published
2012

26. The tissue-type plasminogen activator-plasminogen activator inhibitor 1 complex promotes neurovascular injury in brain trauma: evidence from mice and humans.

Author

Sashindranath M, Sales E, Daglas M, Freeman R, Samson AL, Cops EJ, Beckham S, Galle A, McLean C, Morganti-Kossmann C, Rosenfeld JV, Madani R, Vassalli JD, Su EJ, Lawrence DA, Medcalf RL, Sashindranath, Maithili, Sales, Eunice, Daglas, Maria, and Freeman, Roxann

Abstract

The neurovascular unit provides a dynamic interface between the circulation and central nervous system. Disruption of neurovascular integrity occurs in numerous brain pathologies including neurotrauma and ischaemic stroke. Tissue plasminogen activator is a serine protease that converts plasminogen to plasmin, a protease that dissolves blood clots. Besides its role in fibrinolysis, tissue plasminogen activator is abundantly expressed in the brain where it mediates extracellular proteolysis. However, proteolytically active tissue plasminogen activator also promotes neurovascular disruption after ischaemic stroke; the molecular mechanisms of this process are still unclear. Tissue plasminogen activator is naturally inhibited by serine protease inhibitors (serpins): plasminogen activator inhibitor-1, neuroserpin or protease nexin-1 that results in the formation of serpin:protease complexes. Proteases and serpin:protease complexes are cleared through high-affinity binding to low-density lipoprotein receptors, but their binding to these receptors can also transmit extracellular signals across the plasma membrane. The matrix metalloproteinases are the second major proteolytic system in the mammalian brain, and like tissue plasminogen activators are pivotal to neurological function but can also degrade structures of the neurovascular unit after injury. Herein, we show that tissue plasminogen activator potentiates neurovascular damage in a dose-dependent manner in a mouse model of neurotrauma. Surprisingly, inhibition of activity following administration of plasminogen activator inhibitor-1 significantly increased cerebrovascular permeability. This led to our finding that formation of complexes between tissue plasminogen activator and plasminogen activator inhibitor-1 in the brain parenchyma facilitates post-traumatic cerebrovascular damage. We demonstrate that following trauma, the complex binds to low-density lipoprotein receptors, triggering the induction of matrix metalloproteinase-3. Accordingly, pharmacological inhibition of matrix metalloproteinase-3 attenuates neurovascular permeability and improves neurological function in injured mice. Our results are clinically relevant, because concentrations of tissue plasminogen activator: plasminogen activator inhibitor-1 complex and matrix metalloproteinase-3 are significantly elevated in cerebrospinal fluid of trauma patients and correlate with neurological outcome. In a separate study, we found that matrix metalloproteinase-3 and albumin, a marker of cerebrovascular damage, were significantly increased in brain tissue of patients with neurotrauma. Perturbation of neurovascular homeostasis causing oedema, inflammation and cell death is an important cause of acute and long-term neurological dysfunction after trauma. A role for the tissue plasminogen activator-matrix metalloproteinase axis in promoting neurovascular disruption after neurotrauma has not been described thus far. Targeting tissue plasminogen activator: plasminogen activator inhibitor-1 complex signalling or downstream matrix metalloproteinase-3 induction may provide viable therapeutic strategies to reduce cerebrovascular permeability after neurotrauma. [ABSTRACT FROM AUTHOR]

Published
2012
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28. Cervical interbody fusion is enhanced by allogeneic mesenchymal precursor cells in an ovine model.

Author

Goldschlager T, Rosenfeld JV, Ghosh P, Itescu S, Blecher C, McLean C, and Jenkin G

Abstract

STUDY DESIGN: An experimental study using a sheep cervical spine interbody fusion model. OBJECTIVE: To compare allogeneic mesenchymal precursor cells combined with hydroxyapatite and tricalcium phosphate (HA/TCP) with HA/TCP alone or iliac crest autograft (AG) for cervical interbody fusion. SUMMARY OF BACKGROUND DATA: We investigated the effect of mesenchymal precursor cells on cervical fusion because of the shortcomings of using iliac crest (donor site morbidity), bone substitute (poor osteoinductive properties), and bone morphogenic proteins (serious complications). METHODS: Thirty ewes were divided randomly into four groups of six having C3-C4 anterior cervical discectomy and fusion using a Fidji cage packed with, AG, HA/TCP, HA/TCP containing 5 million MPCs, and HA/TCP containing 10 million MPCs. MPCs were derived from a single batch of immuno-selected and culture-expanded MPCs isolated from bone marrow of out-bred sheep. The fifth group were nonoperated controls. Safety, fusion parameters, and biomechanics were assessed. RESULTS: No cell-related adverse events were observed. No significant differences were found between the five or 10 million MPC groups. Evaluation of fusion by CT scan at 3 months showed that 9 of 12 (75%) MPC-treated animals had continuous bony bridging compared with only 1 of 6 AG and 2 of 6 HA/TCP (P = 0.019 and P = 0.044, respectively). By quantitative CT, density of new bone in MPC-treated animals was 121% higher than in HA/TCP (P = 0.017) and 128% higher than in AG (P < 0.0001). Functional radiology at 3 months revealed that MPC-treated animals had significantly reduced macromotion at C3/4 compared with AG and HA/TCP groups combined (P = 0.007). CONCLUSION: Implantation of allogeneic MPCs when combined with HA/TCP and an interbody spacer facilitates new bone formation after discectomy without any cell-related complications. The earlier and dense new bone formation observed with MPCs relative to autograft and HA/TCP alone suggest that this approach may offer therapeutic benefit. [ABSTRACT FROM AUTHOR]

Published
2011
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29. Early decompressive craniectomy for patients with severe traumatic brain injury and refractory intracranial hypertension -- a pilot randomized trial.

Author

Cooper DJ, Rosenfeld JV, Murray L, Wolfe R, Ponsford J, Davies A, D'Urso P, Pellegrino V, Malham G, and Kossmann T

Abstract

Purpose: The aims of this study were to test the feasibility and to assess potential recruitment rates in a pilot study preliminary to a phase III randomized trial of decompressive craniectomy surgery in patients with diffuse traumatic brain injury (TBI) and refractory intracranial hypertension.Materials and Methods: A study protocol was developed, inclusion and exclusion criteria were defined, and a standardized surgical technique was established. Neurologic outcomes were assessed 6 months after injury with a validated structured questionnaire and a single trained assessor blind to treatment group.Results: During the 8-month pilot study at a level 1 trauma center in Melbourne, Australia, 69 intensive care patients with severe TBI were assessed for inclusion. Six patients were eligible, and 5 (8%) were randomized. Six months after injury, 100% of patients received outcome assessments. Key improvements to the multicenter Decompressive Craniectomy study protocol were enabled by the pilot study.Conclusions: In patients with severe TBI and refractory intracranial hypertension, the frequency of favorable neurologic outcomes (independent living) was low and similar to predicted values (40% favorable). A future multicenter phase III trial involving 18 neurotrauma centers with most sites conservatively recruiting at just 25% of the pilot study rate would require at least 5 years to achieve an estimated 210-patient sample size. Collaboration with neurotrauma centers in countries other than Australia and New Zealand would be required for such a phase III trial to be successful. © 2008 Elsevier Inc. All rights reserved. [ABSTRACT FROM AUTHOR]

Published
2008
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31. Is performance on the Wechsler test of adult reading affected by traumatic brain injury?

Author

Mathias JL, Bowden SC, Bigler ED, and Rosenfeld JV

Abstract

OBJECTIVES: The validity of the National Adult Reading Test (NART) as a predictor of premorbid IQ when used with patients who have sustained a traumatic brain injury (TBI) has been questioned in recent years. This study examined whether performance on the Wechsler Test of Adult Reading (WTAR) is similarly affected by TBI in the first year after an injury. DESIGN AND METHOD: The WTAR scores of participants who had sustained a mild TBI (N=82), moderate TBI (N=73), severe TBI (N=61) or an orthopaedic injury (N=95) were compared (cross-sectional study). A subset of 21 mild TBI, 31 moderate TBI, 26 severe TBI and 21 control group participants were additionally reassessed 6 months later to assess the impact of recovery on WTAR scores (longitudinal study). RESULTS: The severe TBI group had significantly lower scores on the WTAR than the mild TBI, moderate TBI and control groups in the cross-sectional study, despite being matched demographically. The findings from the longitudinal study revealed a significant group difference and a small improvement in performance over time but the interaction between group and time was not significant, suggesting that the improvements in WTAR performance over time were not restricted to more severely injured individuals whose performance was temporarily suppressed. CONCLUSIONS: These findings suggest that reading performance may be affected by severe TBI and that the WTAR may underestimate premorbid IQ when used in this context, which may cause clinicians to underestimate the cognitive deficits experienced by these patients. [ABSTRACT FROM AUTHOR]

Published
2007
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32. A review of the current management of severe traumatic brain injury.

Author

Winter CD, Adamides AA, Lewis PM, Rosenfeld JV, Winter, C D, Adamides, A A, Lewis, P M, and Rosenfeld, J V

Abstract

Traumatic brain injury accounts for up to half of trauma related fatalities. This review describes current management practices including pre-hospital care, surgical interventions and various treatment modalities for intracranial hypertension. The lack of class I evidence for the majority of interventions is highlighted. [ABSTRACT FROM AUTHOR]

Published
2005
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36. Tension pneumo-orbitus and pneumocephalus induced by a nasal oxygen cannula: Report on two paediatric cases.

Author

Professor, Associate, O’Brien, Bj, Rosenfeld, Jv, and Elder, Je

Subjects
PARANASAL sinuses, NEWBORN infant care, CATHETERS, WOUNDS & injuries
Abstract

Abstract: The present paper highlights the potential dangers of misplaced nasopharyngeal oxygen cannulae causing secondary pneumo-orbitus and pneumocephalus in two paediatric patients. While this complication is uncommon, early recognition allows prompt and appropriate intervention, with cessation of nasal oxygen, cannula removal, early investigation with computed tomography (CT) head/orbit scan and orbital or cranial decompression, if required. Early CT imaging identifies medial orbital or paranasal sinus fractures, the presence of sinusitis, associated intracranial air and assessment of the degree of orbital or intracranial tension. Antibiotics are not usually required for this type of clean injury unless pre-existing sinusitis is identified. In both cases, direct orbital decompression was performed with excellent results after identification of marked unilateral tense exophthalmos, delayed pupillary reactions to light and ophthalmopegia. [ABSTRACT FROM AUTHOR]

Published
2000

45. Utility of Acute and Subacute Blood Biomarkers to Assist Diagnosis in CT-Negative Isolated Mild Traumatic Brain Injury.

Author

Reyes J, Spitz G, Major BP, O'Brien WT, Giesler LP, Bain JWP, Xie B, Rosenfeld JV, Law M, Ponsford JL, O'Brien TJ, Shultz SR, Willmott C, Mitra B, and McDonald SJ

Subjects
Adult, Humans, Female, Interleukin-6, Brain, Biomarkers, Glial Fibrillary Acidic Protein, Ubiquitin Thiolesterase, Tomography, X-Ray Computed, Brain Concussion diagnostic imaging, Brain Injuries, Traumatic diagnostic imaging
Abstract

Background and Objectives: Blood biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have recently been Food and Drug Administration approved as predictors of intracranial lesions on CT after mild traumatic brain injury (mTBI). However, most cases with mTBI are CT negative, and no biomarkers are approved to assist diagnosis in these individuals. In this study, we aimed to determine the optimal combination of blood biomarkers to assist mTBI diagnosis in otherwise healthy adults younger than 50 years presenting to an emergency department within 6 hours of injury. To further understand the utility of biomarkers, we assessed how biological sex, presence or absence of loss of consciousness and/or post-traumatic amnesia (LOC/PTA), and delayed presentation affected classification performance., Methods: Blood samples, symptom questionnaires, and cognitive tests were prospectively conducted for participants with mTBI recruited from The Alfred Hospital Level 1 Emergency & Trauma Center and uninjured controls. Follow-up testing was conducted at 7 days. Simoa quantified plasma GFAP, UCH-L1, tau, neurofilament light chain (NfL), interleukin (IL)-6, and IL-1β. Area under the receiver operating characteristic (AUC) analysis assessed classification accuracy for diagnosed mTBI, and logistic regression models identified optimal biomarker combinations., Results: Plasma IL-6 (AUC 0.91, 95% CI 0.86-0.96), GFAP (AUC 0.85, 95% CI 0.78-0.93), and UCH-L1 (AUC 0.79, 95% CI 0.70-0.88) best differentiated mTBI (n = 74) from controls (n = 44) acutely (<6 hours), with NfL (AUC 0.81, 95% CI 0.72-0.90) the only marker to have such utility subacutely (7 days). Biomarker performance was similar between sexes and for participants with and without LOC/PTA, with the exception at 7 days, where GFAP and IL-6 retained some utility in female participants (GFAP: AUC 0.71, 95% CI 0.55-0.88; IL-6: AUC 0.71, 95% CI 0.55-0.87) and in those with LOC/PTA (GFAP: AUC 0.73, 95% CI 0.59-0.86; IL-6: AUC 0.71, 95% CI 0.57-0.84). Acute IL-6 ( R 2 = 0.50, 95% CI 0.34-0.64) outperformed GFAP and UCH-L1 combined ( R 2 = 0.35, 95% CI 0.17-0.50), with the best acute model featuring GFAP and IL-6 ( R 2 = 0.54, 95% CI 0.34-0.68)., Discussion: These findings indicate that adding IL-6 to a panel of brain-specific proteins such as GFAP and UCH-L1 might assist in the acute diagnosis of mTBI in adults younger than 50 years. Multiple markers had high classification accuracy in participants without LOC/PTA. When compared with the best-performing acute markers, subacute measures of plasma NfL resulted in minimal reduction in classification accuracy. Future studies will investigate the optimal time frame over which plasma IL-6 might assist diagnostic decisions and how extracranial trauma affects utility., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Published
2023
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46. MicroRNA biomarkers for diagnosis of mild traumatic brain injury and prediction of persistent symptoms: A prospective cohort study.

Author

Mitra B, Major BP, Reyes J, Surendran N, Bain J, Giesler LP, O'Brien WT, Sorich E, Willmott C, Shultz SR, O'Brien TJ, Rosenfeld JV, and McDonald SJ

Subjects
Adult, Humans, Prospective Studies, Biomarkers, MicroRNAs, Brain Concussion diagnosis, Craniocerebral Trauma
Abstract

The diagnosis of mild traumatic brain injury (mTBI) and early identification of patients who have persistent symptoms remains challenging. Symptoms are variably reported, and tests for cognitive impairment require specific expertise. The aim of this study was to assess the ability of plasma micro-ribonucleic acid (miRNA) biomarkers to distinguish between patients with mTBI and healthy controls. A secondary aim was to assess whether miRNA biomarker levels on the day of injury could predict persistent symptoms on day 7. Injured patients presented to an adult, tertiary referral hospital emergency department and were diagnosed with isolated mTBI (n = 75). Venous blood samples were collected within 6 h of injury. Symptom severity was assessed using the Rivermead Post-Concussion Symptom Questionnaire (RPQ) on the day of injury and at 7 days post-injury. The comparator group (n = 44) were healthy controls without any injury, who had bloods sampled and symptom severity assessed at the same time-point. Patients after mTBI reported higher symptom severity and had worse cognitive performance than the control group. Plasma miR423-3p levels were significantly higher among mTBI patients acutely post-injury compared to healthy controls and provided moderate discriminative ability (AUROC 0.67; 95 %CI: 0.57-0.77). None of the assessed miRNA biomarkers predicted persistent symptoms at 7 days. Plasma miR423-3p levels measured within 6 h of injury can discriminate for mTBI compared to healthy controls, with potential utility for screening after head injury or as an adjunct to the diagnosis of mTBI. Acute plasma miRNA levels did not predict patients who reported persistent symptoms at 7 days., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Published
2023
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47. Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations.

Author

Chesnut RM, Aguilera S, Buki A, Bulger EM, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin RG, Ghajar J, Harris O, Hawryluk GWJ, Hoffer A, Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo DO, Patel MB, Robertson C, Rosenfeld JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein DM, Stocchetti N, Taccone FS, Timmons SD, Tsai EC, Ullman JS, Videtta W, Wright DW, and Zammit C

Subjects
Humans, Intracranial Pressure physiology, Glasgow Coma Scale, Monitoring, Physiologic methods, Brain Injuries, Brain Injuries, Traumatic diagnosis, Intracranial Hypertension diagnosis
Abstract

Background: Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed., Objective: To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion., Methods: We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression., Results: Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations., Conclusion: Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.)

Published
2023
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48. Prognostication and Goals of Care Decisions in Severe Traumatic Brain Injury: A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference Working Group.

Author

Sarigul B, Bell RS, Chesnut R, Aguilera S, Buki A, Citerio G, Cooper DJ, Diaz-Arrastia R, Diringer M, Figaji A, Gao G, Geocadin RG, Ghajar J, Harris O, Hoffer A, Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer SA, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo DO, Patel MB, Robertson C, Rosenfeld JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein DD, Stocchetti N, Taccone FS, Timmons SD, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW, Zammit C, and Hawryluk GWJ

Subjects
Humans, Prognosis, Consensus, Patient Care Planning, Brain Injuries, Traumatic diagnosis, Brain Injuries, Traumatic therapy, Disabled Persons
Abstract

Abstract Best practice guidelines have advanced severe traumatic brain injury (TBI) care; however, there is little that currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the S eattle I nternational severe traumatic B rain I njury C onsensus C onference (SIBICC) participated in a survey consisting of 24 questions. Questions queried use of prognostic calculators, variability in and responsibility for goals of care decisions, and acceptability of neurological outcomes, as well as putative means of improving decisions that might limit care. A total of 97.6% of the 42 SIBICC panelists completed the survey. Responses to most questions were highly variable. Overall, panelists reported infrequent use of prognostic calculators, and observed variability in patient prognostication and goals of care decisions. They felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome as well as what chance of achieving that outcome is acceptable. Panelists felt that the public should help to define what constitutes a good outcome and expressed some support for a "nihilism guard." More than 50% of panelists felt that if it was certain to be permanent, a vegetative state or lower severe disability would justify a withdrawal of care decision, whereas 15% felt that upper severe disability justified such a decision. Whether conceptualizing an ideal or existing prognostic calculator to predict death or an unacceptable outcome, on average a 64-69% chance of a poor outcome was felt to justify treatment withdrawal. These results demonstrate important variability in goals of care decision making and a desire to reduce this variability. Our panel of recognized TBI experts opined on the neurological outcomes and chances of those outcomes that might prompt consideration of care withdrawal; however, imprecision of prognostication and existing prognostication tools is a significant impediment to standardizing the approach to care-limiting decisions.

Published
2023
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49. A Randomized Controlled Trial of the Prevent Alcohol and Risk-Related Trauma in Youth Program in Reducing Alcohol-Related Harms in Young Naval Trainees.

Author

Watterson JR, Gabbe B, Dietze P, and Rosenfeld JV

Subjects
Humans, Adolescent, Alcohol Drinking epidemiology, Alcohol Drinking prevention & control, Australia epidemiology, Ethanol, Alcoholism complications, Substance-Related Disorders complications
Abstract

Background: The aim of this study was to test whether participation in an alcohol risk reduction program known as Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y.) is effective in reducing the prevalence of risky drinking at 12 months' post-intervention in a sample of Royal Australian Navy (RAN) trainees., Methods: A non-blinded randomized controlled trial of 952 RAN trainees comparing two forms of P.A.R.T.Y. plus RAN annual alcohol and other drug awareness training with annual alcohol and other drugs awareness training only (Control). Participants were screened at baseline and at 12-month follow-up using the Alcohol Use Disorders Identification Test (AUDIT). Participants were randomized to one of three arms: (1) in-hospital P.A.R.T.Y program, (2) on-base P.A.R.T.Y. program, or (3) control.The primary outcome measure was the percentage of participants reporting an AUDIT score of 8 or above at 12 months in each group. A secondary outcome considered was reports of alcohol-related incidents in the 12-month follow-up., Results: There was no difference in the risk of reporting an AUDIT score of 8 or above in either the in-hospital (Relative Risk (RR) 0.96, 95% CI: 0.75-1.23; P = .75) or on-base (RR 1.11, 95% CI: 0.89-1.369; P = 0.35) intervention groups, compared to the control group. Compared to the on-base group, there was no difference in the risk of reporting an AUDIT score of 8 or above in the in-hospital group (RR 1.16, 95% CI: 0.90-1.48; P = .24). The rate of reporting an alcohol-related incident was not different for the in-hospital (Hazard Ratio (HR) 0.60, 95% CI: 0.27-1.33; P = .21) or on-base (HR 0.50, 95% CI: 0.21-1.16; P = .11) intervention groups when compared to the control group., Conclusion: Participation in either an on-base or an in-hospital P.A.R.T.Y. program did not affect the proportion of naval trainee participants screening positive for risky drinking on the AUDIT., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2023
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50. Padded Headgear in Junior and Youth Australian Football: Player Insights From a National Survey.

Author

Makovec Knight J, Mitra B, McIntosh A, Clifton P, Makdissi M, Rosenfeld JV, Harcourt P, Howard TS, and Willmott C

Subjects
Adolescent, Female, Humans, Male, Australia, Brain Concussion epidemiology, Brain Concussion prevention & control, Head Protective Devices, Team Sports
Abstract

Objectives: To investigate beliefs and factors associated with padded headgear (HG) use in junior (<13 years) and youth (≥13 years) Australian football., Design: Online survey., Setting: Junior and youth athletes in Australia., Participants: Australian football players aged U8 to U18., Assessment of Variables: Survey questions regarding demographics, HG use, concussion history, beliefs about HG, and risk-taking propensity., Main Outcome Measures: Rates of padded HG use, and beliefs associated with HG use., Results: A total of 735 players (including 190, 25.9% female) representing 206 clubs participated. Headgear was worn by 315 players (42.9%; 95% CI: 39.3-46.4). Most (59.5%) HG users wore it for games only and wore it voluntarily (59.7%), as opposed to being mandated to do so. Junior players were more likely than youth players to agree to feeling safer ( P < 0.001) and being able to play harder while wearing HG ( P < 0.001). Median responses were "disagree" on preferring to risk an injury than wear HG, and on experienced players not needing to wear HG. Beliefs did not differ between males and females. Headgear use was associated with players belonging to a club where HG was mandated for other age groups (OR 16.10; 95% CI: 7.71-33.62, P < 0.001), youth players (OR 2.79; 95% CI: 1.93-3.93, P < 0.001), and female players (OR 1.57; 95% CI: 1.07-2.30, P = 0.019)., Conclusions: Club HG culture, older age and being female were prominent variables associated with voluntary HG use. Players reported believing that HG offers protection. The rate of voluntary and mandated HG use identified is at odds with current scientific evidence that does not support HG as effective concussion prevention., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2023
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