Death after head injury: the 13 year outcome of a case control study

McMillan, T. M.; Teasdale, Graham M.; Weir, Christopher J.; Stewart, Elaine

doi:10.1136/jnnp.2010.222232

Cited by 98 publications

(103 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent 13-year follow-up of their TBI cohort, McMillan and co-workers confirmed the significantly increased mortality rates, independent of trauma severity beyond the first year after injury (McMillan et al, 2011). Mortality rates were particularly high in younger TBI patients, with death rates more than six times higher in patients aged 15-54 years than in community controls matched for age, gender, and deprivation; and more than twice as high as in a second control group matched for duration of hospital admission caused by an injury unrelated to the TBI (McMillan et al, 2011).…”

Section: Introductionmentioning

confidence: 55%

“…Mortality rates were particularly high in younger TBI patients, with death rates more than six times higher in patients aged 15-54 years than in community controls matched for age, gender, and deprivation; and more than twice as high as in a second control group matched for duration of hospital admission caused by an injury unrelated to the TBI (McMillan et al, 2011). According to the authors, the pathomechanisms for the increased mortality rates remain unclear and require further study (McMillan et al, 2011).…”

Section: Introductionmentioning

confidence: 94%

See 1 more Smart Citation

Frequency Analysis Unveils Cardiac Autonomic Dysfunction after Mild Traumatic Brain Injury

Hilz

DeFina

Anders

et al. 2011

Journal of Neurotrauma

138

View full text Add to dashboard Cite

Long-term mortality is increased after mild traumatic brain injury (mTBI). Central cardiovascular-autonomic dysregulation resulting from subtle, trauma-induced brain lesions might contribute to cardiovascular events and fatalities. We investigated whether there is cardiovascular-autonomic dysregulation after mTBI. In 20 mTBI patients (37±13 years, 5-43 months post-injury) and 20 healthy persons (26±9 years), we monitored respiration, RR intervals (RRI), blood pressures (BP), while supine and upon standing. We calculated the root mean square successive RRI differences (RMSSD) reflecting cardiovagal modulation, the ratio of maximal and minimal RRIs around the 30th and 15th RRI upon standing (30:15 ratio) reflecting baroreflex sensitivity (BRS), spectral powers of parasympathetic high-frequency (HF: 0.15-0.5 Hz) RRI oscillations, of mainly sympathetic low-frequency (LF: 0.04-0.15 Hz) RRI oscillations, of sympathetic LF-BP oscillations, RRI-LF/HF-ratios reflecting sympathovagal balance, and the gain between BP and RRI oscillations as additional BRS index (BRS(gain)). We compared supine and standing parameters of patients and controls (repeated measures analysis of variance; significance: p<0.05). While supine, patients had lower RRIs (874.2±157.8 vs. 1024.3±165.4 ms), RMSSDs (30.1±23.6 vs. 56.3±31.4 ms), RRI-HF powers (298.1±309.8 vs. 1507.2±1591.4 ms(2)), and BRS(gain) (8.1±4.4 vs. 12.5±8.1 ms·mmHg(-1)), but higher RRI-LF/HF-ratios (3.0±1.9 vs. 1.2±0.7) than controls. Upon standing, RMSSDs and RRI-HF-powers decreased significantly in controls, but not in patients; patients had lower RRI-30:15-ratios (1.3±0.3 vs. 1.6±0.3) and RRI-LF-powers (2450.0±2110.3 vs. 4805.9±3453.5 ms(2)) than controls. While supine, mTBI patients had reduced cardiovagal modulation and BRS. Upon standing, their BRS was still reduced, and patients did not withdraw parasympathetic or augment sympathetic modulation adequately. Impaired autonomic modulation probably contributes to cardiovascular irregularities post-mTBI.

show abstract

Section: Introductionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 94%

Frequency Analysis Unveils Cardiac Autonomic Dysfunction after Mild Traumatic Brain Injury

Hilz

DeFina

Anders

et al. 2011

Journal of Neurotrauma

138

View full text Add to dashboard Cite

show abstract

“…There is also a much broader inference of a type II error being committed by Rohling et al as they completely ignore all of the collateral information directly implicating non-cognitive residual deficits that may accompany mTBI that are not measured by neuropsychological tests. For example, in a truly prospective longitudinal investigation that has been ongoing for over 13 years, investigators as the University of Glasgow have shown that not only do a substantial number of mTBI patients end up with disability, but mortality rates are substantially increased (McMillan, Teasdale, Weir, & Stewart, 2011), which may in part be related to cardiac autonomic dysfunction even in mTBI (see Hilz et al, 2011). Large-sample TBI studies find increased risk for post-traumatic epilepsy even in mTBI (Ferguson et al, 2010).…”

Section: Current Mtbi Meta-analyses Perpetuate Type II Statistical Errormentioning

confidence: 96%

Reaffirmed Limitations of Meta-Analytic Methods in the Study of Mild Traumatic Brain Injury: A Response to Rohling et al.

Bigler

Farrer

Pertab

et al. 2013

The Clinical Neuropsychologist

View full text Add to dashboard Cite

In 2009 Pertab, James, and Bigler published a critique of two prior meta-analyses by Binder, Rohling, and Larrabee (1997) and Frencham, Fox, and Maybery (2005) that showed small effect size difference at least 3 months post-injury in individuals who had sustained a mild traumatic brain injury (mTBI). The Binder et al. and Frencham et al. meta-analyses have been widely cited as showing no lasting effect of mTBI. In their critique Pertab et al. (2009) point out many limitations of these two prior meta-analyses, demonstrating that depending on how inclusion/exclusion criteria were defined different meta-analytic findings occur, some supporting the persistence of neuropsychological impairments beyond 3 months. Rohling et al. (2011) have now critiqued Pertab et al. (2009). Herein we respond to the Rolling et al. (2011) critique reaffirming the original findings of Pertab et al. (2009), providing additional details concerning the flaws in prior meta-analytic mTBI studies and the effects on neuropsychological performance.

show abstract

“…Impaired CBFV modulation might, in turn, contribute to the pathophysiology of unexplained mortalities in this large group of traumatic brain injury patients. [46][47][48][49] In acute subarachnoid hemorrhages, increased sympathetic tone likely contributes to vasospasms, [50][51][52][53][54] and can be identified by routine TCD recordings with additional spectral analysis. Monitoring of sympathetic CBFV modulation might support therapeutic decisions.…”

Section: Discussionmentioning

confidence: 99%

Autonomic Blockade During Sinusoidal Baroreflex Activation Proves Sympathetic Modulation of Cerebral Blood Flow Velocity

Hilz

Koehn²,

Tillmann³

et al. 2013

Stroke

View full text Add to dashboard Cite

show abstract

Death after head injury: the 13 year outcome of a case control study

Abstract: Head injury is associated with increased vulnerability to death from a variety of causes for at least 13 years after hospital admission. There is a need to understand how head injury influences mortality, particularly in younger adults and after mild head injury.

Cited by 98 publications

References 29 publications

Frequency Analysis Unveils Cardiac Autonomic Dysfunction after Mild Traumatic Brain Injury

Frequency Analysis Unveils Cardiac Autonomic Dysfunction after Mild Traumatic Brain Injury

Reaffirmed Limitations of Meta-Analytic Methods in the Study of Mild Traumatic Brain Injury: A Response to Rohling et al.

Autonomic Blockade During Sinusoidal Baroreflex Activation Proves Sympathetic Modulation of Cerebral Blood Flow Velocity

Contact Info

Product

Resources

About