Severe traumatic brain injury in Norway: Impact of age on outcome

Røe, Cecilie; Skandsen, Toril; Anke, Audny; Ader, Tiina; Vik, Anne; Lund, Stine; Manskow, Unn Sollid; Sollid, Snorre; Sundstrøm, Terje; Hestnes, Morten; Anđelić, Nada

doi:10.2340/16501977-1198

Cited by 26 publications

(18 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The first mechanism , age effects independent of inflammation, is well documented in TBI (Crownover et al , 2012; De Guise et al , 2015; Røe et al , 2013). The single greatest predictor of TBI-related deaths is older age, with nearly a 6% increase in risk of death for each year increase in age after injury (Harrison-Felix et al , 2004).…”

Section: Discussionmentioning

confidence: 99%

Principal components derived from CSF inflammatory profiles predict outcome in survivors after severe traumatic brain injury

Kumar

Rubin

Berger

et al. 2016

Brain, Behavior, and Immunity

View full text Add to dashboard Cite

Studies have characterized absolute levels of multiple inflammatory agents as significant risk factors for poor outcomes after traumatic brain injury (TBI). However, inflammatory marker concentrations are highly inter-related, and production of one may result in the production or regulation of another. Therefore, a more comprehensive characterization of the inflammatory response post-TBI should consider relative levels of markers in the inflammatory pathway. We used principal component analysis (PCA) as a dimension-reduction technique to characterize the sets of markers that contribute independently to variability in cerebrospinal (CSF) inflammatory profiles after TBI. Using PCA results, we defined groups (or clusters) of individuals (n=111) with similar patterns of acute CSF inflammation that were then evaluated in the context of outcome and other relevant CSF and serum biomarkers collected days 0-3 and 4-5 post-injury. We identified four significant principal components (PC1-PC4) for CSF inflammation from days 0-3, and PC1 accounted for the greatest (31%) percentage of variance. PC1 was characterized by relatively higher CSF sICAM-1, sFAS, IL-10, IL-6, sVCAM-1, IL-5, and IL-8 levels. Cluster analysis then defined two distinct clusters, such that individuals in cluster 1 had highly positive PC1 scores and relatively higher levels of CSF cortisol, progesterone, estradiol, testosterone, brain derived neurotrophic factor (BDNF), and S100b; this group also had higher serum cortisol and lower serum BDNF. Multinomial logistic regression analyses showed that individuals in cluster 1 had a 10.9 times increased likelihood of GOS scores of 2/3 versus 4/5 at 6 months compared to cluster 2, after controlling for covariates. Cluster group did not discriminate between mortality compared to GOS scores of 4/5 after controlling for age and other covariates. Cluster groupings also did not discriminate mortality or 12 month outcomes in multivariate models. PCA and cluster analysis establish that a subset of CSF inflammatory markers measured in days 0-3 post-TBI may distinguish individuals with poor 6-month outcome, and future studies should prospectively validate these findings. PCA of inflammatory mediators after TBI could aid in prognostication and in identifying patient subgroups for therapeutic interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Principal components derived from CSF inflammatory profiles predict outcome in survivors after severe traumatic brain injury

Kumar

Rubin

Berger

et al. 2016

Brain, Behavior, and Immunity

View full text Add to dashboard Cite

show abstract

“…The mortality rate of our sample, 33%, is consistent with that found in the literature for severe TBI, which is about 34%. 32 In individuals who have sustained TBI, social and behavioral changes after the injury can be associated with the cognitive impairment acquired due to primary and secondary lesions related to the trauma, particularly those related to executive functions. 33 Thus, at least part of the personality changes displayed by the patient could be associated with this cognitive impairment, which, in turn, is related to the ability of the patient to return to their work activities.…”

Section: Discussionmentioning

confidence: 99%

Personality changes and return to work after severe traumatic brain injury: a prospective study

Diaz

Schwarzbold

Thais

et al. 2014

Rev. Bras. Psiquiatr.

View full text Add to dashboard Cite

Objective: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. Methods: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. Results: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). Conclusions: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition.

show abstract

“…This is most likely a result of the higher incidence of epilepsy in older patients, which reduces the influence of severe TBI as a relative risk factor for unprovoked seizures. A higher mortality after severe TBI in older patients could also have a similar influence on our results, as well as an under ascertainment of elderly patients by SIRE …”

Section: Discussionmentioning

confidence: 99%

Unprovoked seizures after traumatic brain injury: A population‐based case–control study

et al. 2015

View full text Add to dashboard Cite

Relative risks (RRs) for unprovoked seizures were estimated after various TBI diagnoses, and influences of TBI severity and time since trauma were studied in detail. Results: After hospitalization for mild TBI, the RR was 2.0 (95% confidence interval [CI] 1.5-2.7). The RR was higher after brain contusion (5.9, 95% CI 2.4-15.0) or intracranial hemorrhage (ICH) (4.5, 95% CI 2.2-9.0), whereas a combination of both diagnoses led to a further sevenfold increase in RR (42.6, 95% CI 12.2-148.5). The risk was greatest during the first 6 months after severe TBI (RR 48.9, 95% CI 10.9-218.9) or mild TBI (RR 8.1, 95% CI 3.1-21.7), but was still elevated >10 years after any TBI. Significance: Herein we present a large population-based case-control study on TBI as a risk factor for unprovoked epileptic seizures, including cases of all ages with individually validated seizure diagnoses. The risk for epileptic seizures was substantially increased after TBI, especially during the first 6 months after the injury and in patients with a combination of ICH and brain contusion.

show abstract

Severe traumatic brain injury in Norway: Impact of age on outcome

Abstract: Old age is associated with fall-induced severe TBI and high mortality rates. Less intensive treatment strategies were applied to elderly patients in the present study despite high rates of haemorrhage. Few surviving elderly patients received rehabilitation at 3 months post-injury.

Cited by 26 publications

References 39 publications

Principal components derived from CSF inflammatory profiles predict outcome in survivors after severe traumatic brain injury

Principal components derived from CSF inflammatory profiles predict outcome in survivors after severe traumatic brain injury

Personality changes and return to work after severe traumatic brain injury: a prospective study

Unprovoked seizures after traumatic brain injury: A population‐based case–control study

Contact Info

Product

Resources

About