Regional Variations in Rehabilitation Outcomes of Adult Patients With Traumatic Brain Injury: A Uniform Data System for Medical Rehabilitation Investigation

Oyesanya, Tolu O.; Moran, Tim P.; Espinoza, Tamara R.; Wright, David W.

doi:10.1016/j.apmr.2020.07.011

Cited by 9 publications

(6 citation statements)

References 36 publications

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“…Therefore, for these models, the critical point is a database with sufficient data. Although, China collects the TBI information through various systems, such as the Nationally Representative Disease Monitoring Point System (DSP), Hospital Quality Monitoring System (HQMS), and National Injury Monitoring System (NISS), a uniform data system for medical rehabilitation (UDMSR) for the collection of data information in a unified way is currently lacking ( Granger et al, 2010 ; Oyesanya et al, 2021 ). In this study, a database, containing the rehabilitation information of 463 patients, was established.…”

Section: Discussionmentioning

confidence: 99%

Prediction of motor function in patients with traumatic brain injury using genetic algorithms modified back propagation neural network: a data-based study

Dai

Tang

et al. 2023

Front. Neurosci.

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ObjectiveTraumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. In this study, the characteristics of the patients, who were admitted to the China Rehabilitation Research Center, were elucidated in the TBI database, and a prediction model based on the Fugl-Meyer assessment scale (FMA) was established using this database.MethodsA retrospective analysis of 463 TBI patients, who were hospitalized from June 2016 to June 2020, was performed. The data of the patients used for this study included the age and gender of the patients, course of TBI, complications, and concurrent dysfunctions, which were assessed using FMA and other measures. The information was collected at the time of admission to the hospital and 1 month after hospitalization. After 1 month, a prediction model, based on the correlation analyses and a 1-layer genetic algorithms modified back propagation (GA-BP) neural network with 175 patients, was established to predict the FMA. The correlations between the predicted and actual values of 58 patients (prediction set) were described.ResultsMost of the TBI patients, included in this study, had severe conditions (70%). The main causes of the TBI were car accidents (56.59%), while the most common complication and dysfunctions were hydrocephalus (46.44%) and cognitive and motor dysfunction (65.23 and 63.50%), respectively. A total of 233 patients were used in the prediction model, studying the 11 prognostic factors, such as gender, course of the disease, epilepsy, and hydrocephalus. The correlation between the predicted and the actual value of 58 patients was R2 = 0.95.ConclusionThe genetic algorithms modified back propagation neural network can predict motor function in patients with traumatic brain injury, which can be used as a reference for risk and prognosis assessment and guide clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Prediction of motor function in patients with traumatic brain injury using genetic algorithms modified back propagation neural network: a data-based study

Dai

Tang

et al. 2023

Front. Neurosci.

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“…Some studies have suggested that geographic variations may affect the implementation of PAC programs. 27 Therefore, the research results cannot represent the overall effectiveness of all TBI PAC programs in Taiwan. Moreover, there was a higher proportion of younger subjects (<65 years old) in the patients with TBI enrolled in this study.…”

Section: Discussionmentioning

confidence: 99%

Post-Acute Care for Traumatic Brain Injury Patients in Taiwan

Huang¹,

Bih²,

Tsai³

et al. 2023

IJGM

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Background Traumatic brain injury (TBI) can result in functional impairments. Many patients with TBI require post-acute care to improve their functional skills and allow for greater self-independence and a better quality of life. Taiwan’s National Health Insurance proposed a nationwide post-acute care program in 2017 for patients with traumatic brain injury. The program’s goal was to maximize patients’ functional recovery and make it possible for them to return to their homes and communities. This study aimed to explore the effectiveness of such programs in Taiwan. Methods This pilot study retrospectively evaluated a de-identified database that contained the scores of various assessments evaluated at admission and discharge. It used the data to determine the functional improvement of patients with traumatic brain injury after participating in post-acute care programs. Results This study collected complete data from 27 patients. After an average of 45.11 days in the program, the patients showed significant improvement in the Barthel Activity Daily Living Index, the Lawton–Brody Instrumental Activity Daily Living Scale, the Mini Nutrition Assessment, the EuroQol Five Dimensions Questionnaire, the Berg Balance Scale, the Galveston Orientation and Amnesia Test, the Rancho Los Amigos Scale, the Concise Chinese Aphasia Test, and the Mini Mental State Examination. After discharge, 96% of the patients could return to their community. Conclusion This pilot study concluded that the program significantly promoted functional recovery for patients and could help patients with traumatic brain injury return to their communities and reduce the risk of institutionalization. Thus, patients with the potential for functional recovery could receive post-acute care in regional or community hospitals immediately after being discharged from acute wards. In the future randomized controlled trials are needed to further confirm the clinical impact of this program.

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“…The panel mentioned that patients may receive excellent emergency stabilization and acute care, only for funding in post-acute care to be lacking. Oyesanya et al (2021) previously described this phenomenon in a Medicare database study in which they noted significant differences in rehabilitation outcomes following TBI based on geographical location within the United States. In addition, more research is needed to best understand how to optimize patients' rehabilitation needs.…”

Section: Civil Rightsmentioning

confidence: 96%

Prognostic humility and ethical dilemmas after severe brain injury: Summary, recommendations, and qualitative analysis of Curing Coma Campaign virtual event proceedings

Kreitzer

Murtaugh

Creutzfeldt

et al. 2023

Front. Hum. Neurosci.

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BackgroundPatients with severe acute brain injuries (SABI) are at risk of living with long-term disability, frequent medical complications and high rates of mortality. Determining an individual patient’s prognosis and conveying this to family members/caregivers can be challenging. We conducted a webinar with experts in neurosurgery, neurocritical care, neuro-palliative care, neuro-ethics, and rehabilitation as part of the Curing Coma Campaign, which is supported by the Neurocritical Care Society. The webinar discussed topics focused on prognostic uncertainty, communicating prognosis to family members/caregivers, gaps within healthcare systems, and research infrastructure as it relates to patients experiencing SABI. The purpose of this manuscript is to describe the themes that emerged from this virtual discussion.MethodsA qualitative analysis of a webinar “Prognostic Humility and Ethical Dilemmas in Acute Brain Injury” was organized as part of the Neurocritical Care Society’s Curing Coma Campaign. A multidisciplinary group of experts was invited as speakers and moderators of the webinar. The content of the webinar was transcribed verbatim. Two qualitative researchers (NK and BM) read and re-read the transcription, and familiarized themselves with the text. The two coders developed and agreed on a code book, independently coded the transcript, and discussed any discrepancies. The transcript was analyzed using inductive thematic analysis of codes and themes that emerged within the expert discussion.ResultsWe coded 168 qualitative excerpts within the transcript. Two main themes were discussed: (1) the concept of prognostic uncertainty in the acute setting, and (2) lack of access to and evidence for quality rehabilitation and specialized continuum of care efforts specific to coma research. Within these two main themes, we found 5 sub-themes, which were broken down into 23 unique codes. The most frequently described code was the need for clinicians to acknowledge our own uncertainties when we discuss prognosis with families, which was mentioned 13 times during the webinar. Several strategies were described for speaking with surrogates of patients who have had a severe brain injury resulting in SABI. We also identified important gaps in the United States health system and in research to improve the care of patients with severe brain injuries.ConclusionAs a result of this webinar and expert discussion, authors identified and analyzed themes related to prognostic uncertainty with SABI. Recommendations were outlined for clinicians who engage with surrogates of patients with SABI to foster informed decisions for their loved one. Finally, recommendations for changes in healthcare systems and research support are provided in order to continue to propel SABI science forward to improve future prognostic certainty.

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Regional Variations in Rehabilitation Outcomes of Adult Patients With Traumatic Brain Injury: A Uniform Data System for Medical Rehabilitation Investigation

Cited by 9 publications

References 36 publications

Prediction of motor function in patients with traumatic brain injury using genetic algorithms modified back propagation neural network: a data-based study

Prediction of motor function in patients with traumatic brain injury using genetic algorithms modified back propagation neural network: a data-based study

Post-Acute Care for Traumatic Brain Injury Patients in Taiwan

Prognostic humility and ethical dilemmas after severe brain injury: Summary, recommendations, and qualitative analysis of Curing Coma Campaign virtual event proceedings

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