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Liljegren, A. R., Brorsson, C., Karlsson, M., Koskinen, L.-O. D. & Sundström, N. (2023). Cerebrovascular pressure reactivity measures: index comparison and clinical outcome in patients with traumatic brain injury treated according to an intracranial pressure–focused management. Neurotrauma Reports, 4(1), 848-856
Open this publication in new window or tab >>Cerebrovascular pressure reactivity measures: index comparison and clinical outcome in patients with traumatic brain injury treated according to an intracranial pressure–focused management
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2023 (English)In: Neurotrauma Reports, E-ISSN 2689-288X, Vol. 4, no 1, p. 848-856Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate whether the pressure reactivity indices PRx, long-PRx (L-PRx), and pressure reactivity (PR) are interchangeable as measures of vascular reactivity, and whether they correlate with clinical outcome when an intracranial pressure (ICP)-targeted treatment regimen is applied in patients with traumatic brain injury (TBI). Patients with TBI (n = 29) that arrived at the hospital within 24 h of injury were included. PRx and L-PRx were derived from Pearson correlations between mean arterial pressure (MAP) and ICP over a short- and long-time interval. PR was the regression coefficient between the hourly mean values of ICP and MAP. Indices were compared to each other, parameters at admission, and outcome assessed by the extended Glasgow Outcome Scale-Extended (GOSE) at 6 and 12 months. PRx and L-PRx had the strongest correlation with each other (R = 0.536, p < 0.01). A correlation was also noted between L-PRx and PR (R = 0.475, p < 0.01), but not between PRx and PR. A correlation was found between age and PRx (R = 0.482, p = 0.01). No association with outcome for any of the indices was found. PRx/L-PRx and L-PRx/PR were moderately correlated with each other. Age was associated with PRx. None of the indices correlated with outcome when our ICP treatment regime was applied. Part of our null hypothesis, that the three indices are associated with outcome, must be rejected. There was, however, an association between some of the indices. To further understand the relation of treatment regimes and pressure reactivity indices, a larger, randomized study is warranted.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2023
Keywords
neurointensive care, neurosurgery, pressure reactivity indices, traumatic brain injury
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-219526 (URN)10.1089/neur.2023.0074 (DOI)2-s2.0-85181575401 (Scopus ID)
Available from: 2024-01-22 Created: 2024-01-22 Last updated: 2024-01-22Bibliographically approved
van Essen, T. A., van Erp, I. A., Lingsma, H. F., Pisică, D., Yue, J. K., Singh, R. D., . . . Peul, W. C. (2023). Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study. eClinicalMedicine, 63, Article ID 102161.
Open this publication in new window or tab >>Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study
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2023 (English)In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 63, article id 102161Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Limited evidence existed on the comparative effectiveness of decompressive craniectomy (DC) versus craniotomy for evacuation of traumatic acute subdural hematoma (ASDH) until the recently published randomised clinical trial RESCUE-ASDH. In this study, that ran concurrently, we aimed to determine current practice patterns and compare outcomes of primary DC versus craniotomy.

METHODS: We conducted an analysis of centre treatment preference within the prospective, multicentre, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (known as CENTER-TBI) and NeuroTraumatology Quality Registry (known as Net-QuRe) studies, which enrolled patients throughout Europe and Israel (2014-2020). We included patients with an ASDH who underwent acute neurosurgical evacuation. Patients with severe pre-existing neurological disorders were excluded. In an instrumental variable analysis, we compared outcomes between centres according to treatment preference, measured by the case-mix adjusted proportion DC per centre. The primary outcome was functional outcome rated by the 6-months Glasgow Outcome Scale Extended, estimated with ordinal regression as a common odds ratio (OR), adjusted for prespecified confounders. Variation in centre preference was quantified with the median odds ratio (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582).

FINDINGS: Between December 19, 2014 and December 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI of whom 336 (7%) underwent acute surgery for ASDH evacuation; 91 (27%) underwent DC and 245 (63%) craniotomy. The proportion primary DC within total acute surgery cases ranged from 6 to 67% with an interquartile range (IQR) of 12-26% among 46 centres; the odds of receiving a DC for prognostically similar patients in one centre versus another randomly selected centre were trebled (adjusted median odds ratio 2.7, p < 0.0001). Higher centre preference for DC over craniotomy was not associated with better functional outcome (adjusted common odds ratio (OR) per 14% [IQR increase] more DC in a centre = 0.9 [95% CI 0.7-1.1], n = 200). Primary DC was associated with more follow-on surgeries and complications [secondary cranial surgery 27% vs. 18%; shunts 11 vs. 5%]; and similar odds of in-hospital mortality (adjusted OR per 14% IQR more primary DC 1.3 [95% CI (1.0-3.4), n = 200]).

INTERPRETATION: We found substantial practice variation in the employment of DC over craniotomy for ASDH. This variation in treatment strategy did not result in different functional outcome. These findings suggest that primary DC should be restricted to salvageable patients in whom immediate replacement of the bone flap is not possible due to intraoperative brain swelling.

FUNDING: Hersenstichting Nederland for the Dutch NeuroTraumatology Quality Registry and the European Union Seventh Framework Program.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Acute subdural hematoma, Comparative effectiveness research, Craniotomy, Decompressive craniectomy, Instrumental variable analysis, Practice variation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-221574 (URN)10.1016/j.eclinm.2023.102161 (DOI)001063167900001 ()37600483 (PubMedID)2-s2.0-85167581191 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 602150
Available from: 2024-02-27 Created: 2024-02-27 Last updated: 2024-02-28Bibliographically approved
Riemann, L., Mikolic, A., Maas, A., Unterberg, A. & Younsi, A. (2023). Computed tomography lesions and their association with global outcome in young people with mild traumatic brain injury. Journal of Neurotrauma, 40(11-12), 1243-1254
Open this publication in new window or tab >>Computed tomography lesions and their association with global outcome in young people with mild traumatic brain injury
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2023 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 40, no 11-12, p. 1243-1254Article in journal (Refereed) Published
Abstract [en]

Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13-15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a "positive CT" (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17-22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24-0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25-0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2023
Keywords
CT findings, adolescents, children, intracranial lesions, mild TBI, outcome
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-221575 (URN)10.1089/neu.2022.0055 (DOI)000938494700001 ()36578216 (PubMedID)2-s2.0-85160968721 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 602150
Available from: 2024-02-27 Created: 2024-02-27 Last updated: 2024-02-28Bibliographically approved
Erelund, S., Södergren, A., Wiklund, U. & Sundström, N. (2023). Heart rate variability and cardiovascular risk factors in patients with rheumatoid arthritis: a longitudinal study. Autonomic Neuroscience: Basic & Clinical, 249, Article ID 103119.
Open this publication in new window or tab >>Heart rate variability and cardiovascular risk factors in patients with rheumatoid arthritis: a longitudinal study
2023 (English)In: Autonomic Neuroscience: Basic & Clinical, ISSN 1566-0702, E-ISSN 1872-7484, Vol. 249, article id 103119Article in journal (Refereed) Published
Abstract [en]

Background: It is established that the risk of cardiovascular disease (CVD) is increased in patients with Rheumatoid Arthritis (RA). Heart rate variability (HRV) is a method for evaluating the activity in the cardiac autonomic nervous system. Our aim was to assess the longitudinal development of HRV in patients with RA and compare with healthy controls. Furthermore, we wanted to investigate associations between HRV, inflammatory disease activity and cardiovascular complications in patients with RA over time.

Method: HRV was assessed with frequency-domain analysis at baseline and after five years in 50 patients with early RA, all being younger than 60 years. HRV indices were age-adjusted based on the estimated age-dependency in 100 age and sex matched healthy controls. Additionally, clinical data including serological markers, disease activity, and blood pressure were collected from the patients. Eleven years after inclusion CVD was assessed.

Results: At baseline, patients with RA presented with lower HRV compared to controls during deep breathing (6 breaths/min), paced normal breathing (12 breaths/min) and after passive tilt to the upright position. No significant change in HRV was observed at the five-year follow-up. A significant negative correlation was found between HRV parameters and systolic blood pressure (SBP) at baseline. A significant positive correlation was found between heart rate and inflammatory markers at baseline but not after five years. Nine patients had developed CVD after 11 years, but no significant association was found with baseline HRV data.

Conclusion: This study showed that patients with RA have autonomic imbalance both at an early stage of the disease and after five years, despite anti-rheumatic medication, but no correlation between HRV and inflammation markers were observed. Reduced HRV was also significantly negatively correlated with increased SBP. Hypertension is a common finding in patients with RA. Thus, significant decline of HRV could be a useful early marker for development of hypertension in patients with RA.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Autonomic nervous system, Clinical physiology, Heart rate variability, Rheumatoid arthritis
National Category
Cardiac and Cardiovascular Systems Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-214502 (URN)10.1016/j.autneu.2023.103119 (DOI)37703773 (PubMedID)2-s2.0-85170415207 (Scopus ID)
Funder
Region VästerbottenSwedish Research CouncilKnut and Alice Wallenberg FoundationSwedish Rheumatism AssociationVisare NorrSwedish Heart Lung FoundationStiftelsen Konung Gustaf V:s 80-årsfondSwedish Society of Medicine
Available from: 2023-09-21 Created: 2023-09-21 Last updated: 2023-11-02Bibliographically approved
Andersen, L., Appelblad, M., Wiklund, U., Sundström, N. & Svenmarker, S. (2023). Our initial experience of monitoring the autoregulation of cerebral blood flow during cardiopulmonary bypass. The journal of extra-corporeal technology, 55(4), 209-217
Open this publication in new window or tab >>Our initial experience of monitoring the autoregulation of cerebral blood flow during cardiopulmonary bypass
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2023 (English)In: The journal of extra-corporeal technology, ISSN 0022-1058, Vol. 55, no 4, p. 209-217Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cerebral blood flow (CBF) is believed to be relatively constant within an upper and lower blood pressure limit. Different methods are available to monitor CBF autoregulation during surgery. This study aims to critically analyze the application of the cerebral oxygenation index (COx), one of the commonly used techniques, using a reference to data from a series of clinical registrations.

METHOD: CBF was monitored using near-infrared spectroscopy, while cerebral blood pressure was estimated by recordings obtained from either the radial or femoral artery in 10 patients undergoing cardiopulmonary bypass. The association between CBF and blood pressure was calculated as a moving continuous correlation coefficient. A COx index > 0.4 was regarded as a sign of abnormal cerebral autoregulation (CA). Recordings were examined to discuss reliability measures and clinical feasibility of the measurements, followed by interpretation of individual results, identification of possible pitfalls, and suggestions of alternative methods.

RESULTS AND CONCLUSION: Monitoring of CA during cardiopulmonary bypass is intriguing and complex. A series of challenges and limitations should be considered before introducing this method into clinical practice.

Place, publisher, year, edition, pages
EDP Sciences, 2023
Keywords
Autoregulation, Cardiopulmonary bypass, Cerebral blood flow, Monitoring, Near-infrared spectroscopy
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-218633 (URN)10.1051/ject/2023032 (DOI)38099638 (PubMedID)2-s2.0-85179772071 (Scopus ID)
Available from: 2023-12-27 Created: 2023-12-27 Last updated: 2023-12-27Bibliographically approved
Erelund, S., Karp, K., Arvidsson, S., Johansson, B., Sundström, N. & Wiklund, U. (2023). Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden: a comparison with discordant reference values. BMC Pulmonary Medicine, 23(1), Article ID 110.
Open this publication in new window or tab >>Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden: a comparison with discordant reference values
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2023 (English)In: BMC Pulmonary Medicine, E-ISSN 1471-2466, Vol. 23, no 1, article id 110Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Dynamic spirometry is an important investigation to differentiate between impaired and normal lung function. This study aimed to evaluate the results of lung function testing in a cohort of subjects from Northern Sweden without any known heart or pulmonary disease. Our focus was to compare with two reference materials that have showed differences in the age-dependency of lung function in Swedish subjects.

METHODS: The study population consisted of 285 healthy adults (148 males, 52%) between 20-90 years of age. The subjects had been randomly selected from the population register for inclusion in a study investigating cardiac function in heart-healthy subjects, but were also assessed with dynamic spirometry. At least seven percent reported smoking. Sixteen subjects presented with pulmonary functional impairments and were excluded from the current study. The sex-specific age-dependency in lung volumes was estimated using the LMS model, where non-linear equations were derived for the mean value (M), the location (L) or skewness, and the scatter (S) or coefficient of variation. This model of the observed lung function data was compared with reference values given by the original LMS model published by the Global Lung Initiative (GLI), and with the model from the recent Obstructive Lung Disease In Norrbotten (OLIN) study, where higher reference values were presented for Swedish subjects than those given by the GLI model.

RESULTS: No differences were found in the age-dependency of pulmonary function between the LMS model developed in the study and the OLIN model. Although the study group included smokers, the original GLI reference values suggested significantly lower normal values of FEV1 (forced expiratory volume) and FVC (forced vital capacity), and consequently fewer subjects below the lower limit of normality, than both the rederived LMS and OLIN models.

CONCLUSIONS: Our results are in line with previous reports and support that the original GLI reference values underestimate pulmonary function in the adult Swedish population. This underestimation could be reduced by updating the coefficients in the underlying LMS model based on a larger cohort of Swedish citizens than was available in this study.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Clinical physiology, Linear regression, Lung function, Reference values, Spirometry
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-206770 (URN)10.1186/s12890-023-02403-w (DOI)000963360400001 ()37020237 (PubMedID)2-s2.0-85151789612 (Scopus ID)
Available from: 2023-04-26 Created: 2023-04-26 Last updated: 2024-01-17Bibliographically approved
Kals, M., Kunzmann, K., Parodi, L., Radmanesh, F., Wilson, L., Izzy, S., . . . Menon, D. K. (2022). A genome-wide association study of outcome from traumatic brain injury. EBioMedicine, 77, Article ID 103933.
Open this publication in new window or tab >>A genome-wide association study of outcome from traumatic brain injury
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2022 (English)In: EBioMedicine, E-ISSN 2352-3964, Vol. 77, article id 103933Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Factors such as age, pre-injury health, and injury severity, account for less than 35% of outcome variability in traumatic brain injury (TBI). While some residual outcome variability may be attributable to genetic factors, published candidate gene association studies have often been underpowered and subject to publication bias.

METHODS: We performed the first genome- and transcriptome-wide association studies (GWAS, TWAS) of genetic effects on outcome in TBI. The study population consisted of 5268 patients from prospective European and US studies, who attended hospital within 24 h of TBI, and satisfied local protocols for computed tomography.

FINDINGS: The estimated heritability of TBI outcome was 0·26. GWAS revealed no genetic variants with genome-wide significance (p < 5 × 10-8), but identified 83 variants in 13 independent loci which met a lower pre-specified sub-genomic statistical threshold (p < 10-5). Similarly, none of the genes tested in TWAS met tissue-wide significance. An exploratory analysis of 75 published candidate variants associated with 28 genes revealed one replicable variant (rs1800450 in the MBL2 gene) which retained significance after correction for multiple comparison (p = 5·24 × 10-4).

INTERPRETATION: While multiple novel loci reached less stringent thresholds, none achieved genome-wide significance. The overall heritability estimate, however, is consistent with the hypothesis that common genetic variation substantially contributes to inter-individual variability in TBI outcome. The meta-analytic approach to the GWAS and the availability of summary data allows for a continuous extension with additional cohorts as data becomes available.

FUNDING: A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Consortia, Genome-Wide association study, Outcome, Recovery, Traumatic brain injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-215813 (URN)10.1016/j.ebiom.2022.103933 (DOI)000795901400017 ()35301180 (PubMedID)2-s2.0-85126327411 (Scopus ID)
Available from: 2023-10-26 Created: 2023-10-26 Last updated: 2023-10-27Bibliographically approved
Åkerlund, C. A. I., Holst, A., Stocchetti, N., Steyerberg, E. W., Menon, D. K., Ercole, A. & Nelson, D. W. (2022). Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study. Critical Care, 26(1), Article ID 228.
Open this publication in new window or tab >>Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study
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2022 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 26, no 1, article id 228Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classification of traumatic brain injury (TBI) as 'mild', 'moderate' or 'severe' based on this fails to capture enormous heterogeneity in pathophysiology and treatment response. We hypothesized that data-driven characterization of TBI could identify distinct endotypes and give mechanistic insights.

METHODS: We developed an unsupervised statistical clustering model based on a mixture of probabilistic graphs for presentation (< 24 h) demographic, clinical, physiological, laboratory and imaging data to identify subgroups of TBI patients admitted to the intensive care unit in the CENTER-TBI dataset (N = 1,728). A cluster similarity index was used for robust determination of optimal cluster number. Mutual information was used to quantify feature importance and for cluster interpretation.

RESULTS: Six stable endotypes were identified with distinct GCS and composite systemic metabolic stress profiles, distinguished by GCS, blood lactate, oxygen saturation, serum creatinine, glucose, base excess, pH, arterial partial pressure of carbon dioxide, and body temperature. Notably, a cluster with 'moderate' TBI (by traditional classification) and deranged metabolic profile, had a worse outcome than a cluster with 'severe' GCS and a normal metabolic profile. Addition of cluster labels significantly improved the prognostic precision of the IMPACT (International Mission for Prognosis and Analysis of Clinical trials in TBI) extended model, for prediction of both unfavourable outcome and mortality (both p < 0.001).

CONCLUSIONS: Six stable and clinically distinct TBI endotypes were identified by probabilistic unsupervised clustering. In addition to presenting neurology, a profile of biochemical derangement was found to be an important distinguishing feature that was both biologically plausible and associated with outcome. Our work motivates refining current TBI classifications with factors describing metabolic stress. Such data-driven clusters suggest TBI endotypes that merit investigation to identify bespoke treatment strategies to improve care. 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Critical care, Endotypes, Intensive care unit, Machine learning, Traumatic brain injury, Unsupervised clustering
National Category
Anesthesiology and Intensive Care Neurology
Identifiers
urn:nbn:se:umu:diva-221583 (URN)10.1186/s13054-022-04079-w (DOI)000831208500002 ()35897070 (PubMedID)2-s2.0-85135370588 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme
Available from: 2024-02-27 Created: 2024-02-27 Last updated: 2024-02-28Bibliographically approved
Riemann, L., Alhalabi, O. T., Unterberg, A. W. & Younsi, A. (2022). Concomitant spine trauma in patients with traumatic brain injury: Patient characteristics and outcomes. Frontiers in Neurology, 13, Article ID 861688.
Open this publication in new window or tab >>Concomitant spine trauma in patients with traumatic brain injury: Patient characteristics and outcomes
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2022 (English)In: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 13, article id 861688Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Spine injury is highly prevalent in patients with poly-trauma, but data on the co-occurrence of spine trauma in patients with traumatic brain injury (TBI) are scarce. In this study, we used the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) database to assess the prevalence, characteristics, and outcomes of patients with TBI and a concurrent traumatic spinal injury (TSI).

METHODS: Data from the European multi-center CENTER-TBI study were analyzed. Adult patients with TBI (≥18 years) presenting with a concomitant, isolated TSI of at least serious severity (Abbreviated Injury Scale; AIS ≥3) were included. For outcome analysis, comparison groups of TBI patients with TSI and systemic injuries (non-isolated TSI) and without TSI were created using propensity score matching. Rates of mortality, unfavorable outcomes (Glasgow Outcome Scale Extended; GOSe < 5), and full recovery (GOSe 7-8) of all patients and separately for patients with only mild TBI (mTBI) were compared between groups at 6-month follow-up.

RESULTS: A total of 164 (4%) of the 4,254 CENTER-TBI core study patients suffered from a concomitant isolated TSI. The median age was 53 [interquartile range (IQR): 37-66] years and 71% of patients were men. mTBI was documented in 62% of cases, followed by severe TBI (26%), and spine injuries were mostly cervical (63%) or thoracic (31%). Surgical spine stabilization was performed in 19% of cases and 57% of patients were admitted to the ICU. Mortality at 6 months was 11% and only 36% of patients regained full recovery. There were no significant differences in the 6-month rates of mortality, unfavorable outcomes, or full recovery between TBI patients with and without concomitant isolated TSI. However, concomitant non-isolated TSI was associated with an unfavorable outcome and a higher mortality. In patients with mTBI, a negative association with full recovery could be observed for both concomitant isolated and non-isolated TSI.

CONCLUSION: Rates of mortality, unfavorable outcomes, and full recovery in TBI patients with and without concomitant, isolated TSIs were comparable after 6 months. However, in patients with mTBI, concomitant TSI was a negative predictor for a full recovery. These findings might indicate that patients with moderate to severe TBI do not necessarily exhibit worse outcomes when having a concomitant TSI, whereas patients with mTBI might be more affected.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
CENTER-TBI, outcome, spine trauma, traumatic brain injury, traumatic spine injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-221580 (URN)10.3389/fneur.2022.861688 (DOI)000848471100001 ()36062004 (PubMedID)2-s2.0-85138012888 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 602150
Available from: 2024-02-27 Created: 2024-02-27 Last updated: 2024-02-28Bibliographically approved
Retel Helmrich, I. R., van Klaveren, D., Andelic, N., Lingsma, H., Maas, A., Menon, D., . . . Wilson, L. (2022). Discrepancy between disability and reported well-being after traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry, 93(7), 785-96
Open this publication in new window or tab >>Discrepancy between disability and reported well-being after traumatic brain injury
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2022 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 93, no 7, p. 785-96Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Following traumatic brain injury (TBI), the clinical focus is often on disability. However, patients' perceptions of well-being can be discordant with their disability level, referred to as the 'disability paradox'. We aimed to examine the relationship between disability and health-related quality of life (HRQoL) following TBI, while taking variation in personal, injury-related and environment factors into account.

METHODS: We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. Disability was assessed 6 months post-injury by the Glasgow Outcome Scale-Extended (GOSE). HRQoL was assessed by the SF-12v2 physical and mental component summary scores and the Quality of Life after Traumatic Brain Injury overall scale. We examined mean total and domain HRQoL scores by GOSE. We quantified variance in HRQoL explained by GOSE, personal, injury-related and environment factors with multivariable regression.

RESULTS: Six-month outcome assessments were completed in 2075 patients, of whom 78% had mild TBI (Glasgow Coma Scale 13-15). Patients with severe disability had higher HRQoL than expected on the basis of GOSE alone, particularly after mild TBI. Up to 50% of patients with severe disability reported HRQoL scores within the normative range. GOSE, personal, injury-related and environment factors explained a limited amount of variance in HRQoL (up to 29%).

CONCLUSION: Contrary to the idea that discrepancies are unusual, many patients with poor functional outcomes reported well-being that was at or above the boundary considered satisfactory for the normative sample. These findings challenge the idea that satisfactory HRQoL in patients with disability should be described as 'paradoxical' and question common views of what constitutes 'unfavourable' outcome.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
NEUROPSYCHOLOGY, QUALITY OF LIFE, TRAUMATIC BRAIN INJURY
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-221579 (URN)10.1136/jnnp-2021-326615 (DOI)000793935000001 ()35537823 (PubMedID)2-s2.0-85134912841 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 602150
Available from: 2024-02-27 Created: 2024-02-27 Last updated: 2024-02-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3486-5251

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