Prevention of Traumatic Brain Injury in the United States: Significance, New Findings, and Practical Applications

Zvonarev, Valeriy; Rodas, Aaron

doi:10.7759/cureus.11225

Cited by 8 publications

(8 citation statements)

References 36 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This indicates that there appears to be a limit to how much can be done to improve outcomes during this period, beyond those interventions and routines that are already in use. Instead, preventive measures that both reduce the severity and frequency of TBIs are likely of greater importance [ 35 , 36 , 37 ]. Given the significance of age, targeting these measures toward older and more frail populations who are at the greatest risk of adverse outcomes may be particularly effective [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of an XGBoost-Algorithm-Powered Survival Model for Predicting In-Hospital Mortality Based on 545,388 Isolated Severe Traumatic Brain Injury Patients from the TQIP Database

Cao,

Forssten,

Sarani

et al. 2023

JPM

View full text Add to dashboard Cite

Background: Traumatic brain injury (TBI) represents a significant global health issue; the traditional tools such as the Glasgow Coma Scale (GCS) and Abbreviated Injury Scale (AIS) which have been used for injury severity grading, struggle to capture outcomes after TBI. Aim and methods: This paper aims to implement extreme gradient boosting (XGBoost), a powerful machine learning algorithm that combines the predictions of multiple weak models to create a strong predictive model with high accuracy and efficiency, in order to develop and validate a predictive model for in-hospital mortality in patients with isolated severe traumatic brain injury and to identify the most influential predictors. In total, 545,388 patients from the 2013–2021 American College of Surgeons Trauma Quality Improvement Program (TQIP) database were included in the current study, with 80% of the patients used for model training and 20% of the patients for the final model test. The primary outcome of the study was in-hospital mortality. Predictors were patients’ demographics, admission status, as well as comorbidities, and clinical characteristics. Penalized Cox regression models were used to investigate the associations between the survival outcomes and the predictors and select the best predictors. An extreme gradient boosting (XGBoost)-powered Cox regression model was then used to predict the survival outcome. The performance of the models was evaluated using the Harrell’s concordance index (C-index). The time-dependent area under the receiver operating characteristic curve (AUC) was used to evaluate the dynamic cumulative performance of the models. The importance of the predictors in the final prediction model was evaluated using the Shapley additive explanations (SHAP) value. Results: On average, the final XGBoost-powered Cox regression model performed at an acceptable level for patients with a length of stay up to 250 days (mean time-dependent AUC = 0.713) in the test dataset. However, for patients with a length of stay between 20 and 213 days, the performance of the model was relatively poor (time-dependent AUC < 0.7). When limited to patients with a length of stay ≤20 days, which accounts for 95.4% of all the patients, the model achieved an excellent performance (mean time-dependent AUC = 0.813). When further limited to patients with a length of stay ≤5 days, which accounts for two-thirds of all the patients, the model achieved an outstanding performance (mean time-dependent AUC = 0.917). Conclusion: The XGBoost-powered Cox regression model can achieve an outstanding predictive ability for in-hospital mortality during the first 5 days, primarily based on the severity of the injury, the GCS on admission, and the patient’s age. These variables continue to demonstrate an excellent predictive ability up to 20 days after admission, a period of care that accounts for over 95% of severe TBI patients. Past 20 days of care, other factors appear to be the primary drivers of in-hospital mortality, indicating a potential window of opportunity for improving outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Development and Validation of an XGBoost-Algorithm-Powered Survival Model for Predicting In-Hospital Mortality Based on 545,388 Isolated Severe Traumatic Brain Injury Patients from the TQIP Database

Cao,

Forssten,

Sarani

et al. 2023

JPM

View full text Add to dashboard Cite

show abstract

“…Traumatic brain injury (TBI) is an important medical, economic and social problem, which has a high rate of mortality and morbidity. Considering the public health policy, the implementation of prevention, education and rehabilitation strategies in TBI, the international incidence of TBI varies between countries [1][2][3].…”

Section: Background and Aimsmentioning

confidence: 99%

The impact of oral anticoagulants on the characteristics of subdural hematomas and other brain lesions in patients with traumatic brain injury

Pastor

Para

Vesa

et al. 2023

Medicine and Pharmacy Reports

View full text Add to dashboard Cite

Background and aim. The aim of the study was to determine the impact of prior anticoagulant treatment on the characteristics of intracranial hematomas. Methods. We included in this retrospective study 135 patients who were diagnosed with subdural hematoma in the context of traumatic brain injury. We recorded the demographic and clinical data, the paraclinical examinations and the characteristics of subdural hematoma evidenced by preoperative computed tomography (CT). We also reported the other brain injuries, entailed by primary and secondary lesions, as described by CT. Results. The anticoagulation therapy was recorded in 35 patients, at the moment of diagnosis. Acute subdural hematoma was recorded in 89 (65.9%) patients, 21 (60%) of these had anticoagulation therapy on admission. There were 46 (34.1%) patients with chronic subdural hematoma, 14 (40%) of these were on anticoagulant therapy. The midline shift was significantly moved in patients with anticoagulation therapy. The thickness of the subdural hematoma was significantly higher in patients with anticoagulation. We did not find any significant association of the other brain lesions (cranial fracture, extradural hematoma, intraparenchymal hematoma, nor intracranial hypertension, brain herniation, brain swelling), and the presence of anticoagulation therapy. Conclusion. The study showed that anticoagulants significantly influence some neuroimaging aspects of the SDH in head trauma.

show abstract

“…The majority of TBI survivors have worse health outcomes than the general population, and only a quarter of them get long-term functional independence ( Ahmed et al, 2017 ). Thus, TBI prevention programs have been launched by many countries to reduce the injury itself and to mitigate the severity of related medical and social consequences ( Fatuki et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Whole Body Vibration Attenuates Brain Damage and Neuroinflammation Following Experimental Traumatic Brain Injury

Chen

Liu

Ren

et al. 2022

Front. Cell Dev. Biol.

View full text Add to dashboard Cite

Traumatic brain injury (TBI) is still a major public health problem worldwide, and the research of neuroprotective drugs has encountered great difficulties. Whole body vibration (WBV) is a safe and powerful rehabilitative intervention in various clinical settings, but its effect on neurological diseases is not well documented. In this study, we investigated the effects of WBV pretreatment on brain damage following experimental TBI mimicked by controlled cortical impact (CCI) in mice. C57BL/6 J male mice were expose to WBV at 30 Hz twice per day for 20 days and injured by CCI. WBV had no effect on animal body weight, but significantly reduced the TBI-induced brain edema in the cortex. The results of immunostaining showed that the activation of microglia and astrocytes induced by TBI in brain sections was attenuated by WBV. In consistent, WBV markedly inhibited the expression of pro-inflammatory cytokines, while increased the levels of anti-inflammatory cytokine interleukin 10 (IL-10). In addition, WBV pretreatment alleviated neuronal apoptosis in the cortex and suppressed the cleavage of the apoptotic executive molecule caspase-1. The neurological dysfunction following TBI was determined by open field test and Morris Water Maze (MWM) assay. The results showed that motor activity, learning and memory ability were preserved by WBV compared to TBI-injured mice. In summary, our present data identified WBV as a clinically potent strategy with which to attenuate TBI-related brain damage through regulating neuroinflammation.

show abstract

Prevention of Traumatic Brain Injury in the United States: Significance, New Findings, and Practical Applications

Cited by 8 publications

References 36 publications

Development and Validation of an XGBoost-Algorithm-Powered Survival Model for Predicting In-Hospital Mortality Based on 545,388 Isolated Severe Traumatic Brain Injury Patients from the TQIP Database

Development and Validation of an XGBoost-Algorithm-Powered Survival Model for Predicting In-Hospital Mortality Based on 545,388 Isolated Severe Traumatic Brain Injury Patients from the TQIP Database

The impact of oral anticoagulants on the characteristics of subdural hematomas and other brain lesions in patients with traumatic brain injury

Whole Body Vibration Attenuates Brain Damage and Neuroinflammation Following Experimental Traumatic Brain Injury

Contact Info

Product

Resources

About