Discriminating military and civilian traumatic brain injuries

Reid, Matthew; Vélez, Carmen

doi:10.1016/j.mcn.2015.03.014

Cited by 42 publications

(22 citation statements)

References 67 publications

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“…Patient demographic, clinical, and laboratory variables were dichotomized according to unfavorable and favorable 6-month neurological outcome and shown in Table 1 . A total of 159 patients were included in the study, the majority (n = 100; 62.9%) of which had an unfavorable GOSE ( 1 – 4 ) prognosis at 6 months postinjury. Forty-four (27.7%) patients died, 61.4% of these by neurologic death and 38.6% by non-neurologic organ failure.…”

Section: Resultsmentioning

confidence: 99%

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Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury

Battista

Rizoli

Lejnieks

et al. 2016

Shock

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Background:Acute coagulopathy after traumatic brain injury (TBI) involves a complex multifactorial hemostatic response that is poorly characterized. Objectives: To examine early posttraumatic alterations in coagulofibrinolytic, endothelial, and inflammatory blood biomarkers in relation to sympathetic nervous system (SNS) activation and 6-month patient outcomes, using multivariate partial least-squares (PLS) analysis.Patients and Methods:A multicenter observational study of 159 adult isolated TBI patients admitted to the emergency department at an urban level I trauma center, was performed. Plasma concentrations of 6 coagulofibrinolytic, 10 vascular endothelial, 19 inflammatory, and 2 catecholamine biomarkers were measured by immunoassay on admission and 24 h postinjury. Neurological outcome at 6 months was assessed using the Extended Glasgow Outcome Scale. PLS-discriminant analysis was used to identify salient biomarker contributions to unfavorable outcome, whereas PLS regression analysis was used to evaluate the covariance between SNS correlates (catecholamines) and biomarkers of coagulopathy, endotheliopathy, and inflammation.Results:Biomarker profiles in patients with an unfavorable outcome displayed procoagulation, hyperfibrinolysis, glycocalyx and endothelial damage, vasculature activation, and inflammation. A strong covariant relationship was evident between catecholamines and biomarkers of coagulopathy, endotheliopathy, and inflammation at both admission and 24 h postinjury.Conclusions:Biomarkers of coagulopathy and endotheliopathy are associated with poor outcome after TBI. Catecholamine levels were highly correlated with endotheliopathy and coagulopathy markers within the first 24 h after injury. Further research is warranted to characterize the pathogenic role of SNS-mediated hemostatic alterations in isolated TBI.

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Section: Resultsmentioning

confidence: 99%

“…Traumatic brain injury (TBI) is a major cause of death and disability in both civilian and military populations ( 1 ). Although less common than mild head injuries ( 2 ), moderate-to-severe TBI is often life threatening ( 3 ), causing secondary injury complications that dramatically worsen patient outcome ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury

Battista

Rizoli

Lejnieks

et al. 2016

Shock

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“…There are important differences between the pre-injury characteristics, mechanisms of injury, health care services, and recovery trajectories between people who sustain an MTBI in sport, military, and civilian trauma settings[ 68 , 69 ]. Prior studies examining traumatic injuries of all kinds have reported that people who are injured in workplace accidents are at elevated risk for poor outcomes[ 7 , 70 ].…”

Section: Discussionmentioning

confidence: 99%

Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study

et al. 2018

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Individuals who are injured in the workplace typically have a greater risk of delayed return to work (RTW) and other poor health outcomes compared to those not injured at work. It is not known whether these differences hold true for mild traumatic brain injuries (MTBI). The present study examined differences associated with workplace and non-workplace MTBI upon intake to a specialty MTBI clinic, their outcomes, and risk factors that influence RTW. Slow-to-recover participants were recruited from consecutive referrals to four outpatient MTBI clinics from March 2015 to February 2017. Two clinics treat Worker’s Compensation claimants and two clinics serve patients with non-work related injuries in the publically funded health care system. Of 273 eligible patients, 102 completed an initial study assessment (M age = 41.2 years, SD age = 11.7; 54% women) at an average of 2–3 months post injury. Participants were interviewed about their MTBI and completed a battery of standardized questionnaires and performance validity testing. Outcomes, including RTW, were assessed via telephone follow-up 4–5 months later. Workplace injuries comprised 45.1% of the sample. The workplace MTBI group had a greater proportion of men and lower education levels compared to the non-workplace MTBI group. The two groups had a comparable post-concussion symptom burden and performance validity test failure rate. Workplace MTBI was associated with greater post-traumatic stress symptoms. Fifteen patients (14.7%) were lost to follow-up. There were no workplace/non-workplace MTBI differences in RTW outcome at 6–7 months post injury. Of the entire sample, 42.5% of patients had full RTW, 18.4% had partial RTW, and 39.1% had no RTW. Greater post-concussion symptom burden was most predictive of no RTW at follow-up. There was no evidence that the workplace and non-workplace MTBI groups had different risk factors associated with prolonged work absence. Despite systemic differences in compensation and health care access, the workplace and non-workplace MTBI groups were similar at clinic intake and indistinguishable at follow-up, 6–7 months post injury.

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“…[30][31][32] Military TBI occurs in combination with a multitude of environmental and physical factors, including psychological hazards. 33 Several symptoms observed in mbTBI or repeated mbTBI (rmbTBI) can be triggered by psychological trauma(s) alone without organic injury, diagnosed as PTSD. Persons experiencing PTSD re-experience the stressful event/trauma, thereby reinforcing the negative association of certain triggers and causing them to become/remain reactive for an extended period.…”

Section: Blast Scenariosmentioning

confidence: 99%

Modeling the Long-Term Consequences of Repeated Blast-Induced Mild Traumatic Brain Injuries

Agoston

2017

Journal of Neurotrauma

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Repeated mild traumatic brain injury (rmTBI) caused by playing collision sports or by exposure to blasts during military operations can lead to late onset, chronic diseases such as chronic traumatic encephalopathy (CTE), a progressive neurodegenerative condition that manifests in increasingly severe neuropsychiatric abnormalities years after the last injury. Currently, because of the heterogeneity of the clinical presentation, confirmation of a CTE diagnosis requires post-mortem examination of the brain. The hallmarks of CTE are abnormal accumulation of phosphorylated tau protein, TDP-43 immunoreactive neuronal cytoplasmic inclusions, and astroglial abnormalities, but the pathomechanism leading to these terminal findings remains unknown. Animal modeling can play an important role in the identification of CTE pathomechanisms, the development of early stage diagnostic and prognostic biomarkers, and pharmacological interventions. Modeling the long-term consequences of blast rmTBI in animals is especially challenging because of the complexities of blast physics and animal-to-human scaling issues. This review summarizes current knowledge about the pathobiologies of CTE and rmbTBI and discusses problems as well as potential solutions related to high-fidelity modeling of rmbTBI and determining its long-term consequences.

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Discriminating military and civilian traumatic brain injuries

Cited by 42 publications

References 67 publications

Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury

Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury

Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study

Modeling the Long-Term Consequences of Repeated Blast-Induced Mild Traumatic Brain Injuries

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