Prognostic Value of Major Extracranial Injury in Traumatic Brain Injury

Leeuwen, Nikki van; Lingsma, Hester F.; Perel, Pablo; Lecky, Fiona; Roozenbeek, Bob; Lü, Juan; Shakur, Haleema; Weir, James; Steyerberg, Ewout W.; Maas, Andrew I. R.

doi:10.1227/neu.0b013e318235d640

Cited by 91 publications

(42 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data for killed victims after TBI are in accordance with others, who showed that non-cranial injury occurrence increased the risk of early mortality [40]. This increase in severe extra-cranial injuries might be explained either by a change in RTC victim recruitment (increased share of pedal cyclists and/or PTW users), or by modifications in procedures allowing a more sensitive diagnosis of TBI (i.e.…”

Section: Discussionsupporting

confidence: 89%

The Decrease in Traumatic Brain Injury Epidemics Deriving from Road Traffic Collision Following Strengthened Legislative Measures in France

et al. 2016

View full text Add to dashboard Cite

BackgroundSince 2002, France has been strengthening legislation on road traffic. This study is intended to evaluate the changes in Traumatic Brain Injury (TBI) incidence and mortality resulting from Road Traffic Collision (RTC) in the two 6-year periods before and after 2002.MethodsWe used a Registry of all RTC casualties in the Rhône Department of France. Each casualty was coded according to the Abbreviated Injury Scale (AIS). The study describes changes in demographic variables, TBI (AIS ≥ 2) incidence and mortality, other body lesions (AIS ≥ 3) associated with TBI, road user types, seatbelt and helmet wearing.FindingsRTC casualty occurrences decreased by 21% (from 64,312 to 50,746) during the period after 2002. TBI occurrence accounted for 8.6% and 6.7% of all RTC in both periods. This corresponds to a reduction of TBI casualty incidence (-42%), which was much more pronounced than RTC casualty incidence (-25%) (p < 0.0001). Severe and critical TBI (AIS-4 and -5) incidences were reduced by half as much (-21%), compared to TBI incidence. TBI mortality rate (among population) and lethality (among TBI related to RTC casualties) decreased 56% and 23%, respectively. This reduction particularly affected car occupants and victims who deceased. TBI incidence decreased 43% in all 10-year age classes until 60 on average, this decrease declining with age in the period after 2002. After adjustment for age, sex, road user types, and severity of lesions at the head and other body regions, logistic regression analysis displayed a protective effect of the period following 2002, on the risk of death after RTC-related TBI.InterpretationThe greater reductions in the incidence, severity and mortality of TBI when compared with the reduction of casualty incidence have mainly affected car users. These results should be attributable to the improvements in standards of care, primary safety of the car fleet and general road architecture safety. However, the increased reduction in the TBI epidemics in France, when compared to those observed in other developed countries for the same periods, suggests that the effects should be strongly attributable to changes in road user behaviour induced by law enforcement. The at-risk groups for TBI after RTC are now two-wheel users (motorized or not) and individuals over 60 years of age.

show abstract

Section: Discussionsupporting

confidence: 89%

The Decrease in Traumatic Brain Injury Epidemics Deriving from Road Traffic Collision Following Strengthened Legislative Measures in France

et al. 2016

View full text Add to dashboard Cite

show abstract

“…8 Also, in the TRIPOD statement, there is an item on the reporting of treatment received among participants of a study developing or validating a multivariable prediction model for diagnosis or prognosis. 9 In this article, we evaluate these different methods in situations that aim to develop a prognostic model generating predictions in case individuals were to remain untreated, which serve as input for treatment decisions.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Explicit inclusion of treatment in prognostic modeling was recommended in observational and randomized settings

Groenwold

Moons

Pajouheshnia

et al. 2016

Journal of Clinical Epidemiology

View full text Add to dashboard Cite

What is new• When developing a prognostic model (that aims to produce accurate probabilities of the outcome in case the patient is not treated) using data from a randomised trial in which individuals from one arm do not receive treatment, restricting the analysis to untreated individuals may be a suitable strategy. However, removing all patients in the treatment group will reduce the sample size, leading to greater uncertainty around predictions and also to prognostic models that are more prone to overfitting.• When developing a prognostic model using data from observational studies with treated patients, restricting the analysis to untreated individuals is not appropriate if treatment status depends on patient characteristics, including the predictors of the developed model.• For either randomised or observational studies, it is preferable to explicitly model treatment when developing a prognostic model.

show abstract

“…In fact, major extracranial injury has been reported as a prognostic factor for mortality in patients with TBI, but the strength of the effect is smaller in patients with more severe brain injury as is the most likely to occur in our series of patients who presented a high rate of isolated severe TBI from assault. 54,55 Besides the brain, the release of cell-free DNA from injured cells may occur peripherally, because DNA is present in the nucleus/ mitochondria of the majority of cell types and can be released into the circulation. Thus, extracerebral sources may contribute to the increase plasma DNA levels after multitrauma.…”

Section: Figmentioning

confidence: 99%

Elevated Cell-Free Plasma DNA Level as an Independent Predictor of Mortality in Patients with Severe Traumatic Brain Injury

Filho

Simon

Ikuta

et al. 2014

Journal of Neurotrauma

View full text Add to dashboard Cite

Trauma is the leading cause of death in individuals less than 45 years old worldwide, and up to 50% of trauma fatalities are because of brain injury. Prediction of outcome is one of the major problems associated with severe traumatic brain injury (TBI), and research efforts have focused on the investigation of biomarkers with prognostic value after TBI. Therefore, our aim was to investigate whether cell-free DNA concentrations correlated to short-term primary outcome (survival or death) and Glasgow Coma Scale (GCS) scores after severe TBI. A total of 188 patients with severe TBI were enrolled in this prospective study; outcome variables comprised survival and neurological assessment using the GCS at intensive care unit (ICU) discharge. Control blood samples were obtained from 25 healthy volunteers. Peripheral venous blood was collected at admission to the ICU. Plasma DNA was measured using a real-time quantitative polymerase chain reaction (PCR) assay for the b-globin gene. There was correlation between higher DNA levels and both fatal outcome and lower hospital admission GCS scores. Plasma DNA concentrations at the chosen cutoff point ( ‡ 171,381 kilogenomesequivalents/L) predicted mortality with a specificity of 90% and a sensitivity of 43%. Logistic regression analysis showed that elevated plasma DNA levels were independently associated with death ( p < 0.001). In conclusion, high cell-free DNA concentration was a predictor of short-term mortality after severe TBI.

show abstract

Prognostic Value of Major Extracranial Injury in Traumatic Brain Injury

Abstract: MEI is an important prognostic factor for mortality in TBI patients. However, the effect varies by population, which explains the controversy in the literature. The strength of the effect is smaller in patients with more severe brain injury and depends on time of inclusion in a study.

Cited by 91 publications

References 17 publications

The Decrease in Traumatic Brain Injury Epidemics Deriving from Road Traffic Collision Following Strengthened Legislative Measures in France

The Decrease in Traumatic Brain Injury Epidemics Deriving from Road Traffic Collision Following Strengthened Legislative Measures in France

Explicit inclusion of treatment in prognostic modeling was recommended in observational and randomized settings

Elevated Cell-Free Plasma DNA Level as an Independent Predictor of Mortality in Patients with Severe Traumatic Brain Injury

Contact Info

Product

Resources

About