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Publications (10 of 64) Show all publications
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
Zickerman, C., Brorsson, C., Hultin, M., Johansson, G., Winsö, O. & Haney, M. (2023). Preoperative anxiety level is not associated with postoperative negative behavioral changes in premedicated children. Acta Anaesthesiologica Scandinavica, 67(6), 706-713
Open this publication in new window or tab >>Preoperative anxiety level is not associated with postoperative negative behavioral changes in premedicated children
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2023 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 67, no 6, p. 706-713Article in journal (Refereed) Published
Abstract [en]

Background: Anesthesia preinduction anxiety in children can according to some studies lead to long-term anxiety and negative behavioral changes (NBC), while other studies have not found this effect. This secondary analysis from a recent premedication trial comparing clonidine and midazolam aimed to test the relation between preoperative anxiety assessed with modified Yale Preoperative Anxiety Scale (mYPAS) and postoperative NBCs assessed with Post Hospital Behavior Questionnaire (PHBQ), regardless of premedication type.

Methods: This is a planned secondary analysis from a published premedication comparison trial in an outpatient surgery cohort, children aged 2–7 years. Participant and preoperative factors, particularly preoperative anxiety as mYPAS scores, were assessed for association with development of postoperative NBCs.

Results: Fifty-four of the 115 participants had high preinduction anxiety (mYPAS >30), and 19 of 115 developed >3 postoperative NBCs 1 week after surgery. There was no association between preinduction anxiety level as mYPAS scores and the development of postoperative NBCs at 1 week after surgery (10 of 19 had both, p =.62) nor after 4- or 26-weeks post-surgery. Only lower age was associated with development of NBCs postoperatively.

Conclusions: Based on the findings from this cohort, high preinduction anxiety does not appear to be associated with NBCs postoperatively in children premedicated with clonidine or midazolam.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
children, postoperative negative behavioral changes, postoperative recovery, preoperative anxiety
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-206762 (URN)10.1111/aas.14240 (DOI)000962252500001 ()36928794 (PubMedID)2-s2.0-85151972127 (Scopus ID)
Funder
Umeå UniversityRegion Västerbotten
Available from: 2023-05-02 Created: 2023-05-02 Last updated: 2023-12-05Bibliographically approved
Mikolić, A., Steyerberg, E. W., Polinder, S., Wilson, L., Zeldovich, M., von Steinbuechel, N., . . . van Klaveren, D. (2023). Prognostic models for global functional outcome and post-concussion symptoms following mild traumatic brain injury: a collaborative european neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) study. Journal of Neurotrauma, 40(15-16), 1651-1670
Open this publication in new window or tab >>Prognostic models for global functional outcome and post-concussion symptoms following mild traumatic brain injury: a collaborative european neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) study
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2023 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 40, no 15-16, p. 1651-1670Article in journal (Refereed) Published
Abstract [en]

After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at presentation (Clinical model). The Clinical model was then extended with variables assessed before discharge from hospital: early post-concussion symptoms, CT variables, biomarkers, or all three categories (extended models). In a subset of patients mostly discharged home from the emergency department, the Clinical model was extended with 2-3-week post-concussion and mental health symptoms. Predictors were selected based on Akaike's Information Criterion. Performance of ordinal models was expressed as a concordance index (C) and performance of linear models as proportion of variance explained (R2). Bootstrap validation was used to correct for optimism. We included 2376 mTBI patients with 6-month GOSE and 1605 patients with 6-month RPQ. The Core and Clinical models for GOSE showed moderate discrimination (C = 0.68 95% confidence interval 0.68 to 0.70 and C = 0.70[0.69 to 0.71], respectively) and injury severity was the strongest predictor. The extended models had better discriminative ability (C = 0.71[0.69 to 0.72] with early symptoms; 0.71[0.70 to 0.72] with CT variables or with blood biomarkers; 0.72[0.71 to 0.73] with all three categories). The performance of models for RPQ was modest (R2 = 4% Core; R2 = 9% Clinical), and extensions with early symptoms increased the R2 to 12%. The 2-3-week models had better performance for both outcomes in the subset of participants with these symptoms measured (C = 0.74 [0.71 to 0.78] vs. C = 0.63[0.61 to 0.67] for GOSE; R2 = 37% vs. 6% for RPQ). In conclusion, the models based on variables available before discharge have moderate performance for the prediction of GOSE and poor performance for the prediction of PPCS. Symptoms assessed at 2-3 weeks are required for better predictive ability of both outcomes. The performance of the proposed models should be examined in independent cohorts.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2023
Keywords
biomarkers, Glasgow Outcome Scale Extended, mild traumatic brain injury, post-concussion symptoms, predictors, prognostic model
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-216232 (URN)10.1089/neu.2022.0320 (DOI)000993931100001 ()37078144 (PubMedID)2-s2.0-85168315877 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 602150
Available from: 2023-11-06 Created: 2023-11-06 Last updated: 2023-11-06Bibliographically 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
Volovici, V., Pisică, D., Gravesteijn, B. Y., Dirven, C. M. F., Steyerberg, E. W., Ercole, A., . . . Lingsma, H. F. (2022). Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. Acta Neurochirurgica, 164(7), 1693-1705
Open this publication in new window or tab >>Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study
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2022 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 164, no 7, p. 1693-1705Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare outcomes between patients with primary external ventricular device (EVD)-driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)-driven treatment.

METHODS: The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with "center" as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome.

RESULTS: A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36-1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34-2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs.

CONCLUSION: We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor-guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
CENTER-TBI, EVD, External ventricular devices, ICP, Intracranial hypertension, Intracranial pressure monitoring, Intraparenchymal monitors, Severe TBI, Traumatic brain injury
National Category
Anesthesiology and Intensive Care Neurology Surgery
Identifiers
urn:nbn:se:umu:diva-221585 (URN)10.1007/s00701-022-05257-z (DOI)000804526800001 ()35648213 (PubMedID)2-s2.0-85131406979 (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
Galimberti, S., Graziano, F., Maas, A. I. R., Isernia, G., Lecky, F., Jain, S., . . . Citerio, G. (2022). Effect of frailty on 6-month outcome after traumatic brain injury: a multicentre cohort study with external validation. Lancet Neurology, 21(2), 153-162
Open this publication in new window or tab >>Effect of frailty on 6-month outcome after traumatic brain injury: a multicentre cohort study with external validation
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2022 (English)In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 21, no 2, p. 153-162Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Frailty is known to be associated with poorer outcomes in individuals admitted to hospital for medical conditions requiring intensive care. However, little evidence is available for the effect of frailty on patients' outcomes after traumatic brain injury. Many frailty indices have been validated for clinical practice and show good performance to predict clinical outcomes. However, each is specific to a particular clinical context. We aimed to develop a frailty index to predict 6-month outcomes in patients after a traumatic brain injury.

METHODS: A cumulative deficit approach was used to create a novel frailty index based on 30 items dealing with disease states, current medications, and laboratory values derived from data available from CENTER-TBI, a prospective, longitudinal observational study of patients with traumatic brain injury presenting within 24 h of injury and admitted to a ward or an intensive care unit at 65 centres in Europe between Dec 19, 2014, and Dec 17, 2017. From the individual cumulative CENTER-TBI frailty index (range 0-30), we obtained a standardised value (range 0-1), with high scores indicating higher levels of frailty. The effect of frailty on 6-month outcome evaluated with the extended Glasgow Outcome Scale (GOSE) was assessed through a proportional odds logistic model adjusted for known outcome predictors. An unfavourable outcome was defined as death or severe disability (GOSE score ≤4). External validation was performed on data from TRACK-TBI, a prospective observational study co-designed with CENTER-TBI, which enrolled patients with traumatic brain injury at 18 level I trauma centres in the USA from Feb 26, 2014, to July 27, 2018. CENTER-TBI is registered with ClinicalTrials.gov, NCT02210221; TRACK-TBI is registered at ClinicalTrials.gov, NCT02119182.

FINDINGS: 2993 participants (median age was 51 years [IQR 30-67], 2058 [69%] were men) were included in this analysis. The overall median CENTER-TBI frailty index score was 0·07 (IQR 0·03-0·15), with a median score of 0·17 (0·08-0·27) in older adults (aged ≥65 years). The CENTER-TBI frailty index score was significantly associated with the probability of an increasingly unfavourable outcome (cumulative odds ratio [OR] 1·03, 95% CI 1·02-1·04; p<0·0001), and the association was stronger for participants admitted to hospital wards (1·04, 1·03-1·06, p<0·0001) compared with those admitted to the intensive care unit (1·02, 1·01-1·03 p<0·0001). External validation of the CENTER-TBI frailty index in data from the TRACK-TBI (n=1667) cohort supported the robustness and reliability of these findings. The overall median TRACK-TBI frailty index score was 0·03 (IQR 0-0·10), with the frailty index score significantly associated with the risk of an increasingly unfavourable outcome in patients admitted to hospital wards (cumulative OR 1·05, 95% CI 1·03-1·08; p<0·0001), but not in those admitted to the intensive care unit (1·01, 0·99-1·03; p=0·43).

INTERPRETATION: We developed and externally validated a frailty index specific to traumatic brain injury. Risk of unfavourable outcome was significantly increased in participants with a higher CENTER-TBI frailty index score, regardless of age. Frailty identification could help to individualise rehabilitation approaches aimed at mitigating effects of frailty in patients with traumatic brain injury.

FUNDING: European Union, Hannelore Kohl Stiftung, OneMind, Integra LifeSciences Corporation, NeuroTrauma Sciences, NIH-NINDS-TRACK-TBI, US Department of Defense.

Place, publisher, year, edition, pages
Elsevier, 2022
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-215815 (URN)10.1016/S1474-4422(21)00374-4 (DOI)000769111800016 ()35065038 (PubMedID)2-s2.0-85122939948 (Scopus ID)
Available from: 2023-10-26 Created: 2023-10-26 Last updated: 2023-10-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2113-8098

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