Objective Prior studies have suggested that traumatic brain injury (TBI) may affect cardiac function. Our study aims were to determine the incidence, longitudinal course, and admission risk factors for systolic dysfunction in patients with moderate-severe TBI. Design Prospective cohort study Setting Level 1 trauma center Measurements Transthoracic echocardiogram (TTE) within 1 day and over the first week after moderate-severe TBI; TTE within 1 day after mild TBI (comparison group). Measurements and Main Results Systolic function was assessed by TTE, and systolic dysfunction was defined as fractional shortening (FS) < 25%. Multivariable Poisson regression models examined admission risk factors for systolic dysfunction. Systolic function in 32 patients with isolated moderate-severe TBI and 32 patients with isolated mild TBI (comparison group) was assessed with TTE. Seven (22%) moderate-severe TBI and 0 (0%) mild TBI patients had systolic dysfunction within the first day after injury (p<0.01). All patients with early systolic dysfunction recovered in one week. Younger age (RR 0.87, 95% CI 0.79 – 0.94, for one year increase in age) and lower admission GCS score (RR 0.34, 95% CI 0.20 – 0.58, for one unit increase in GCS) were independently associated with the development of systolic dysfunction among moderate-severe TBI patients. Conclusions Early systolic dysfunction can occur in previously healthy patients with moderate-severe TBI, and it is reversible over the first week of hospitalization. Younger age and lower admission GCS score are independently associated with the development of systolic dysfunction after moderate-severe TBI.

Traumatic brain injury (TBI) is a major public health problem, with severe TBI contributing to a large number of deaths and disability worldwide. Early hypotension has been linked with poor outcomes following severe TBI, and guidelines suggest early and aggressive management of hypotension after TBI. Despite these recommendations, no guidelines exist for the management of hypertension after severe TBI, although observational data suggests that early hypertension is also associated with an increased risk of mortality after severe TBI. The purpose of this review is to discuss the underlying pathophysiology of hypertension after TBI, provide an overview of the current clinical data on early hypertension after TBI, and discuss future research that should test the benefits and harms of treating high blood pressure in TBI patients.

Objective: To develop a framework to identify targeted areas for improving health literacy for caregivers after traumatic brain injury (TBI). Method: Qualitative study using inductive and deductive qualitative content analysis was conducted in a large, urban, level I trauma center. Interviews were conducted with 23 caregivers of persons TBI. Participants perspectives on communication and preparation for discharge were explored and understanding of commonly used words and discharge instructions were assessed. Results: Four types of communication patterns were identified: formal, informal, indirect, and caregiver-initiated. Informal and caregiver-initiated communication were most common. All caregivers reported confusion about family member’s condition, care plan or discharge plan. Caregivers were not able to define commonly used terms in discharge instructions, and were confused by formatting and medical language. Caregivers were not aware of expected caregiving roles upon discharge. Conceptualizing findings within a Family-Centered Care model, we offer specific strategies to improve health communication and caregiver capacity building to enhance health literacy. Conclusions: Health literacy and caregiver capacity to care for loved ones with TBI after hospital discharge is low. We offer specific targets for improvement in the areas of verbal and written communication and capacity building that take into account provider, patient, and family characteristics.