Mortality Following Hospital Admission for US Active Duty Service Members Diagnosed With Penetrating Traumatic Brain Injury, 2004–2014

Regasa, Lemma Ebssa; Kaplan, Dorothy A.; Martin, Elisabeth Moy; Langbein, Jean; Johnson, Felicia; Chase, Lcdr Carla

doi:10.1097/htr.0000000000000380

Cited by 10 publications

(4 citation statements)

References 17 publications

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“…Five retrospective cohort studies addressed screening, diagnosis, health care use, and health trajectories. Female service members were hospitalized less often than male service members for penetrating TBI and were less likely to die after hospitalization ( n = 1226; 3% female) . In outpatient VHA care, females were screened for TBI at a lower rate than males ( n = 330 000; 12%‐13% female) and were three times less likely to complete a comprehensive TBI evaluation if they had a positive screen ( n = 465; 4.5% female) .…”

Section: Resultsmentioning

confidence: 99%

“…Female service members were hospitalized less often than male service members for penetrating TBI and were less likely to die after hospitalization (n = 1226; 3% female). 27 In outpatient VHA care, females were screened for TBI at a lower rate than males (n = 330 000; 12%-13% female) 28 and were three times less likely to complete a comprehensive TBI evaluation if they had a positive screen (n = 465; 4.5% female). 29 After a positive TBI screen or diagnosis, females used more outpatient services than men and incurred higher costs, 28 but used inpatient services less frequently (n = 12 144; 5.9% female).…”

Section: Tbi Identification and Health Care Utilizationmentioning

confidence: 99%

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Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans

Cogan

McCaughey

Scholten

2019

PM&R

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This scoping study describes the range of outcomes in traumatic brain injury (TBI) studies of military service members and veterans addressing gender differences. A secondary purpose is to identify differences in outcomes between male and female participants in such studies. We searched PubMed, CiNAHL, and PsycInfo databases for relevant articles. Two reviewers independently screened results. Of 822 unique titles and abstracts screened for eligibility, 55 full articles were reviewed, with 29 studies meeting full inclusion criteria. Twenty of the 29 included studies used retrospective designs and all but two used data collected from Veterans Affairs or Department of Defense health care settings. TBI was diagnosed by self‐report, screening, and evaluation procedures, and medical record documentation. Ten different outcome categories were identified among the included studies. In general, female service members and veterans have not been well represented in TBI outcomes research. Evidence suggests that female veterans with mild TBI (mTBI) report more neurobehavioral symptoms and use more outpatient services than male veterans. Studies also indicate that female veterans with TBI are more frequently diagnosed with depression. Additional research is essential to support precision treatment recommendations for female veterans with TBI, as women represent a growing proportion of the patients served by the Veterans Health Administration. Level of Evidence IV

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Section: Resultsmentioning

confidence: 99%

Section: Tbi Identification and Health Care Utilizationmentioning

confidence: 99%

Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans

Cogan

McCaughey

Scholten

2019

PM&R

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“…This percentage is similar to results from other studies, which too report mortality rates of more than 40%. [5][6][7] These patients usually require no intervention other than airway and circulatory procedures. The management of these patients focuses on deciding whether, depending on injury severity, emergency surgery or further diagnostic and imaging procedures should be performed.…”

Section: Discussionmentioning

confidence: 99%

Penetrating injuries in Germany – Epidemiology, management and outcome - An analysis based on the TraumaRegister DGU®

Bieler

Kollig²,

Hackenberg³

et al. 2021

Preprint

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Background The management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5% of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment. Materials and methods Since 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. Results From 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5%, and 4333 patients with stab wounds (1.8%), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41% for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8%). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3% required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit. Conclusions In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.

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“… 5–7 Timely neurosurgical intervention, improved neuroimaging, and acute trauma management have lowered the firearm fatality rate. 8 , 9 Spontaneous recovery in TBI generally takes place in the first 3 months after injury, allowing a low percentage of TBI survivors to return to work; however, this has been stagnant for the past five decades. 10–12 Currently, surviving a pTBI most likely culminates in permanent disability.…”

Section: Introductionmentioning

confidence: 99%

Injury-Transplantation Interval-Dependent Amelioration of Axonal Degeneration and Motor Deficit in Rats with Penetrating Traumatic Brain Injury

Andreu

Sanchez

Spurlock

et al. 2023

Neurotrauma Reports

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Penetrating traumatic brain injury (pTBI) is increasingly survivable, but permanently disabling as adult mammalian nervous system does not regenerate. Recently, our group demonstrated transplant location-dependent neuroprotection and safety of clinical trial–grade human neural stem cell (hNSC) transplantation in a rodent model of acute pTBI. To evaluate whether longer injury-transplantation intervals marked by chronic inflammation impede engraftment, 60 male Sprague-Dawley rats were randomized to three sets. Each set was divided equally into two groups: 1) with no injury (sham) or 2) pTBI. After either 1 week (groups 1 and 2), 2 weeks (groups 3 and 4), or 4 weeks after injury (groups 5 and 6), each animal received 0.5 million hNSCs perilesionally. A seventh group of pTBI animals treated with vehicle served as the negative control. All animals were allowed to survive 12 weeks with standard chemical immunosuppression. Motor capacity was assessed pre-transplant to establish injury-induced deficit and followed by testing at 8 and 12 weeks after transplantation. Animals were euthanized, perfused, and examined for lesion size, axonal degeneration, and engraftment. Compared to vehicle, transplanted groups showed a trend for reduced lesion size and axonal injury across intervals. Remote secondary axonal injury was significantly reduced in groups 2 and 4, but not in group 6. The majority of animals showed robust engraftment independent of the injury-transplant time interval. Modest amelioration of motor deficit paralleled the axonal injury trend. In aggregate, pTBI-induced remote secondary axonal injury was resolved by early, but not delayed, hNSC transplantation.

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Mortality Following Hospital Admission for US Active Duty Service Members Diagnosed With Penetrating Traumatic Brain Injury, 2004–2014

Abstract: This study quantifies case fatality rate among hospitalized US SMs with the diagnosis of PTBI. We report a 23.1% crude case fatality rate among the current cohort. Early intensive care for these patients may be the key to improving survival rates.

Cited by 10 publications

References 17 publications

Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans

Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans

Penetrating injuries in Germany – Epidemiology, management and outcome - An analysis based on the TraumaRegister DGU®

Injury-Transplantation Interval-Dependent Amelioration of Axonal Degeneration and Motor Deficit in Rats with Penetrating Traumatic Brain Injury

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