scholarly journals Predicting 14-Day Mortality after Severe Traumatic Brain Injury: Application of the IMPACT Models in the Brain Trauma Foundation TBI-trac® New York State Database

2012 ◽  
Vol 29 (7) ◽  
pp. 1306-1312 ◽  
Author(s):  
Bob Roozenbeek ◽  
Ya-Lin Chiu ◽  
Hester F. Lingsma ◽  
Linda M. Gerber ◽  
Ewout W. Steyerberg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
New York ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
New York State ◽  
York State ◽  
Brain Trauma Foundation ◽  
The Impact ◽  
The Brain ◽  
Impact Models

scholarly journals Marked reduction in mortality in patients with severe traumatic brain injury

2013 ◽  
Vol 119 (6) ◽  
pp. 1583-1590 ◽  
Author(s):  
Linda M. Gerber ◽  
Ya-Lin Chiu ◽  
Nancy Carney ◽  
Roger Härtl ◽  
Jamshid Ghajar
Keyword(s):  
Traumatic Brain Injury ◽  
New York ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
New York State ◽  
Case Fatality ◽  
York State ◽  
Brain Trauma Foundation ◽  
Guidelines Adherence ◽  
Generalized Linear Mixed Effects

Object In spite of evidence that use of the Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury (Guidelines) would dramatically reduce morbidity and mortality, adherence to these Guidelines remains variable across trauma centers. The authors analyzed 2-week mortality due to severe traumatic brain injury (TBI) from 2001 through 2009 in New York State and examined the trends in adherence to the Guidelines. Methods The authors calculated trends in adherence to the Guidelines and age-adjusted 2-week mortality rates between January 1, 2001, and December 31, 2009. Univariate and multivariate logistic regression analyses were performed to evaluate the effect of time period on case-fatality. Intracranial pressure (ICP) monitor insertion was modeled in a 2-level hierarchical model using generalized linear mixed effects to allow for clustering by different centers. Results From 2001 to 2009, the case-fatality rate decreased from 22% to 13% (p < 0.0001), a change that remained significant after adjusting for factors that independently predict mortality (adjusted OR 0.52, 95% CI 0.39–0.70; p < 0.0001). Guidelines adherence increased, with the percentage of patients with ICP monitoring increasing from 56% to 75% (p < 0.0001). Adherence to cerebral perfusion pressure treatment thresholds increased from 15% to 48% (p < 0.0001). The proportion of patients having an ICP elevation greater than 25 mm Hg dropped from 42% to 29% (p = 0.0001). Conclusions There was a significant reduction in TBI mortality between 2001 and 2009 in New York State. Increase in Guidelines adherence occurred at the same time as the pronounced decrease in 2-week mortality and decreased rate of intracranial hypertension, suggesting a causal relationship between Guidelines adherence and improved outcomes. Our findings warrant future investigation to identify methods for increasing and sustaining adherence to evidence-based Guidelines recommendations.

Effect of early nutrition on deaths due to severe traumatic brain injury

2008 ◽  
Vol 109 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Roger Härtl ◽  
Linda M. Gerber ◽  
Quanhong Ni ◽  
Jamshid Ghajar
Keyword(s):  
Traumatic Brain Injury ◽  
New York ◽  
Brain Injury ◽  
New York State ◽  
Arterial Hypotension ◽  
Improvement Program ◽  
Health Crisis ◽  
York State ◽  
Severe Tbi ◽  
Gcs Score

Object Traumatic brain injury (TBI) remains a serious public health crisis requiring continuous improvement in pre-hospital and inhospital care. This condition results in a hypermetabolic state that increases systemic and cerebral energy requirements, but achieving adequate nutrition to meet this demand has not been a priority in reducing death due to TBI. The effect of timing and quantity of nutrition on death within the first 2 weeks of injury was analyzed in a large prospective database of adult patients with severe TBI in New York State. Methods The study is based on 797 patients with severe TBI (Glasgow Coma Scale [GCS] score < 9) treated at 22 trauma centers enrolled in a New York State quality improvement program between 2000 and 2006. The inhospital section of the prospectively collected database includes information on age, initial GCS score, weight and height, results of CT scanning, and daily parameters such as pupillary status, arterial hypotension, GCS score, and number of calories fed per day. Results Patients who were not fed within 5 and 7 days after TBI had a 2- and 4-fold increased likelihood of death, respectively. The amount of nutrition in the first 5 days was related to death; every 10-kcal/kg decrease in caloric intake was associated with a 30–40% increase in mortality rates. This held up even after controlling for factors known to affect mortality, including arterial hypotension, age, pupillary status, initial GCS score, and CT scan findings. Conclusions Nutrition is a significant predictor of death due to TBI. Together with prevention of arterial hypotension, hypoxia, and intracranial hypertension it is one of the few therapeutic interventions that can directly affect TBI outcome.

Treatment of Severe Traumatic Brain Injury in the Scandinavian Countries, with Special Emphasis on the Lund Concept

Neurotrauma ◽  
2018 ◽  
pp. 29-40
Author(s):  
Magnus Olivecrona ◽  
Per-Olof Grände
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Fluid Therapy ◽  
Cerebral Perfusion ◽  
Brain Perfusion ◽  
Brain Trauma ◽  
Volume Control ◽  
Brain Trauma Foundation ◽  
The Brain

The Lund concept (LC) and the Brain Trauma Foundation (BTF) guidelines are used in Scandinavia and the Nordic countries to treat severe brain trauma (s-TBI). In this chapter, the authors focus on the LC developed in Scandinavia. When introduced in 1992, it was a theoretical approach, based mainly on principles of brain volume control and of optimization of brain perfusion. The BTF guidelines presented in 1996 were based on meta-analytic approaches. The LC gives relatively strict outlines regarding cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The treatment is standardized, with less need for individualization.

scholarly journals The effect of ICP monitoring in severe traumatic brain injury: a propensity score–weighted and adjusted regression approach

2019 ◽  
Vol 131 (6) ◽  
pp. 1896-1904 ◽  
Author(s):  
Pål Rønning ◽  
Eirik Helseth ◽  
Nils-Oddvar Skaga ◽  
Knut Stavem ◽  
Iver A. Langmoen
Keyword(s):  
Traumatic Brain Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Propensity Score ◽  
Regression Model ◽  
Severe Traumatic Brain Injury ◽  
Logistic Regression Model ◽  
Icp Monitoring ◽  
Brain Trauma Foundation ◽  
The Impact

OBJECTIVEThe use of intracranial pressure (ICP) monitoring has been postulated to be beneficial in patients with severe traumatic brain injury (TBI), although studies investigating this hypothesis have reported conflicting results. The objective of this study was to evaluate the effect of inserting an ICP monitor on survival in patients with severe TBI.METHODSThe Oslo University Hospital trauma registry was searched for the records of all patients admitted between January 1, 2002, and December 31, 2013, who fulfilled the Brain Trauma Foundation criteria for intracranial hypertension and who survived at least 24 hours after admission. The impact of ICP monitoring was investigated using both a logistic regression model and a multiple imputed, propensity score–weighted logistic regression analysis.RESULTSThe study involved 1327 patients, in which 757 patients had an ICP monitor implanted. The use of ICP monitors significantly increased in the study period (p < 0.01). The 30-day overall mortality was 24.3% (322 patients), divided into 35.1% (200 patients, 95% confidence interval [CI] 31.3%–39.1%) in the group without an ICP monitor and 16.1% (122 patients, 95% CI 13.6%–18.9%) in the group with an ICP monitor. The impact of ICP monitors on 30-day mortality was found to be beneficial both in the complete case analysis logistic regression model (odds ratio [OR] 0.23, 95% CI 0.16–0.33) and in the adjusted, aggregated, propensity score–weighted imputed data sets (OR 0.22, 95% CI 0.15–0.35; both p < 0.001). The sensitivity analysis indicated that the findings are robust to unmeasured confounders.CONCLUSIONSThe authors found that the use of an ICP monitor is significantly associated with improved survival in patients with severe head injury.

scholarly journals Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary

Neurosurgery ◽  
2019 ◽  
Vol 84 (6) ◽  
pp. 1169-1178 ◽  
Author(s):  
Patrick M Kochanek ◽  
Robert C Tasker ◽  
Nancy Carney ◽  
Annette M Totten ◽  
P David Adelson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Trauma ◽  
Executive Summary ◽  
Brain Trauma Foundation ◽  
The Brain

scholarly journals Engineered glycomaterial implants orchestrate large-scale functional repair of brain tissue chronically after severe traumatic brain injury

2021 ◽  
Vol 7 (10) ◽  
pp. eabe0207
Author(s):  
Charles-Francois V. Latchoumane ◽  
Martha I. Betancur ◽  
Gregory A. Simchick ◽  
Min Kyoung Sun ◽  
Rameen Forghani ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Large Scale ◽  
Growth Factor Signaling ◽  
Neuronal Circuit ◽  
Reach To Grasp ◽  
Function Recovery ◽  
Cellular Repair ◽  
The Brain

Severe traumatic brain injury (sTBI) survivors experience permanent functional disabilities due to significant volume loss and the brain’s poor capacity to regenerate. Chondroitin sulfate glycosaminoglycans (CS-GAGs) are key regulators of growth factor signaling and neural stem cell homeostasis in the brain. However, the efficacy of engineered CS (eCS) matrices in mediating structural and functional recovery chronically after sTBI has not been investigated. We report that neurotrophic factor functionalized acellular eCS matrices implanted into the rat M1 region acutely after sTBI significantly enhanced cellular repair and gross motor function recovery when compared to controls 20 weeks after sTBI. Animals subjected to M2 region injuries followed by eCS matrix implantations demonstrated the significant recovery of “reach-to-grasp” function. This was attributed to enhanced volumetric vascularization, activity-regulated cytoskeleton (Arc) protein expression, and perilesional sensorimotor connectivity. These findings indicate that eCS matrices implanted acutely after sTBI can support complex cellular, vascular, and neuronal circuit repair chronically after sTBI.

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