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  • 1. Bazarian, Jeffrey J
    et al.
    Zemlan, Frank P
    Mookerjee, Sohug
    Stigbrand, Torgny
    Umeå University, Faculty of Medicine, Clinical Microbiology. Umeå University, Faculty of Medicine, Clinical Microbiology, Immunology/Immunchemistry.
    Serum S-100B and cleaved-tau are poor predictors of long-term outcome after mild traumatic brain injury.2006In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 20, no 7, p. 759-65Article in journal (Refereed)
    Abstract [en]

    PRIMARY OBJECTIVE: To determine the relationship of serum S-100B and C-tau levels to long-term outcome after mild traumatic brain injury (mild TBI). RESEARCH DESIGN: A prospective study of 35 mild TBI subjects presenting to the emergency department. METHODS AND PROCEDURES: Six hour serum S-100B and C-tau levels compared to 3-month Rivermead Post Concussion Questionnaire (RPCQ) scores and post-concussive syndrome (PCS). MAIN OUTCOMES AND RESULTS: The linear correlation between marker levels and RPCQ scores was weak (S-100B: r = 0.071, C-tau: r = -0.21). There was no statistically significant correlation between marker levels and 3-month PCS (S-100B: AUC = 0.589, 95%CI. 038, 0.80; C-tau: AUC = 0.634, 95%CI 0.43, 0.84). The sensitivity of these markers ranged from 43.8-56.3% and the specificity from 35.7-71.4%. CONCLUSIONS: Initial serum S-100B and C-tau levels appear to be poor predictors of 3-month outcome after mild TBI.

  • 2.
    Berginström, Nils
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Ekman, Urban
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Eriksson, Johan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Andersson, Micael
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Fatigue after traumatic brain injury is linked to altered striato-thalamic-cortical functioning2017In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 31, no 6-7, p. 755-755Article in journal (Refereed)
    Abstract [en]

    Mental fatigue is a common symptom in the chronic phase of traumatic brain injury. Despite its high prevalence, no treatmentis available for this disabling symptom, and the mechanisms underlying fatigue are poorly understood. Some studies have suggested that fatigue in traumatic brain injury and other neurological disorders might reflect dysfunction within striato-thalamic-cortical loops. In the present study, we investigated whether functional magnetic resonance imaging(fMRI) can be used to detect chronic fatigue after traumatic brain injury (TBI), with emphasis on the striato-thalamic cortical-loops. We included patients who had suffered traumatic brain injury (n = 57, age range 20–64 years) and experienced mental fatigue > 1 year post injury (mean = 8.79 years, SD = 7.35), and age- and sex-matched healthycontrols (n = 27, age range 25–65 years). All participants completed self-assessment scales of fatigue and other symptoms, underwent an extensive neuropsychological test battery and performed a fatiguing 27-minute attention task (the modified Symbol Digit Modalities Test) during fMRI. Accuracy did not differ between groups, but reaction times were slower in the traumatic brain injury group (p < 0.001). Patients showed a greater increase in fatigue than controls from before to after task completion (p < 0.001). Patients showed less fMRI blood oxygen level–dependent activity in several a priori hypothesized regions (family-wise error corrected,p < 0.05), including the bilateral caudate, thalamus and anterior insula. Using the left caudate as a region of interest and testing for sensitivity and specificity, we identified 91% of patients and 81% of controls. As expected, controls showed decreased activation over time in regions of interest—the bilateral caudate and anterior thalamus (p < 0.002, uncorrected)—whereas patients showed no corresponding activity decrease. These results suggest that chronic fatigue after TBI is linked to altered striato-thalamic-cortical functioning. The high precision of fMRI for the detection of fatigue is of great clinical interest, given the lack of objective measures for the diagnosis of fatigue.

  • 3.
    Berginström, Nils
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. School of Sport Sciences, The Arctic University of Norway, Tromsø, Norway..
    White matter hyperintensities increases with traumatic brain injury severity: associations to neuropsychological performance and fatigue2020In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 34, no 3, p. 415-420Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the prevalence of white matter hyperintensities (WMHs) in patients with traumatic brain injury (TBI) as compared to healthy controls, and to investigate whether there is an association between WMH lesion burden and performance on neuropsychological tests in patients with TBI.

    Methods: A total of 59 patients with TBI and 27 age- and gender-matched healthy controls underwent thorough neuropsychological testing and magnetic resonance imaging. The quantification of WMH lesions was performed using the fully automated Lesion Segmentation Tool.

    Results: WMH lesions were more common in patients with TBI than in healthy controls (p = .032), and increased with higher TBI severity (p = .025). Linear regressions showed that WMH lesions in patients with TBI were not related to performance on any neuropsychological tests (p > .05 for all). However, a negative relationship between number of WMH lesions in patients with TBI and self-assessed fatigue was found (r = - 0.33, p = .026).

    Conclusion: WMH lesions are more common in patients with TBI than in healthy controls, and WMH lesions burden increases with TBI severity. These lesions could not explain decreased cognitive functioning in patients with TBI but did relate to decreased self-assessment of fatigue after TBI.

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  • 4. Godbolt, Alison
    et al.
    Nygren-DeBoussard, Catharina
    Stenberg, Maud
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ulfarsson, Trandur
    Lindgren, Marie
    Karlsdottir, Gudrun
    Borg, Jorgen
    Cognitive recovery in the first 3 months after severe traumatic brain injury: preliminary data from "PROBRAIN'' study2012In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, no 4-5, p. 639-639Article in journal (Other academic)
  • 5.
    Johansson, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Life satisfaction related to work re-entry after brain injury: A longitudinal study2003In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 17, no 11, p. 991-1002Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to assess the subjective life satisfaction after brain injury and its relation to work re-entry. METHOD: The research design was a longitudinal study. Thirty-six individuals answered a questionnaire at 3 and 6 years after admittance to a rehabilitation programme. The questionnaire addressed work status, job satisfaction, subjective symptoms of illness and life satisfaction. RESULTS: The reported life satisfaction both for life as a whole and for different domains of life was low. No significant difference between follow-ups was found for satisfaction with life as a whole. For the domain IADL activities, the subjects reported a statistically significant lower satisfaction at the second follow-up than at the first. No correlation between work status and subjective satisfaction with life as a whole was found in this population. At the second follow-up, significantly more people were satisfied with IADL in the group that had returned to work. CONCLUSIONS: The results from this study indicate that brain injury has a lasting effect on a person's life also many years after onset. The decreasing satisfaction with the ability to perform IADL-activities in along-term perspective should give implications for clinical practice. More research in this area is needed.

  • 6. Kassberg, Ann-Charlotte
    et al.
    Malinowsky, Camilla
    Jacobsson, Lars
    Larsson Lund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Luleå University of Technology.
    Ability to manage everyday technology after acquired brain injury2013In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 27, no 13-14, p. 1583-1588Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate and describe how persons with an acquired brain injury (ABI) manage everyday technology (ET) in their daily activities and to explore whether the ability to manage ET was related to the severity of the disability. Method: Eighty-one persons with ABI were observed while managing ET by using the Management of Everyday Technology Assessment (META). The Glasgow Outcome Scale-Extended (GOSE) was used to assess the severity of disability after the ABI. A computer application of a Rasch measurement model was used to generate measures of the participants' ability to manage ET and the measures were compared groupwise with analysis of covariance (ANCOVA). Results: The degree of severity of disability had a significant main effect on the ability to manage ET. The groups with severe and moderate disability exhibited a significantly lower ability to manage ET compared to the group with good recovery. Conclusion: The result indicates that the ability to manage ET in daily activities can be related to the global severity of disability after ABI. This demonstrates the importance of considering the ability to manage ET to support the performance of activities at home, at work and in society in persons with ABI.

  • 7.
    Kim, Sonya
    et al.
    Department of Neurology and Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, United States.
    Mortera, Marianne
    NYU Steinhardt, Department of Occupational Therapy, New York University, New York, United States.
    Heyn, Patricia
    Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, VA, Arlington, United States.
    Sood, Pallavi
    Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, VA, Arlington, United States.
    Wen, Pey-Shan
    Lewis College of Nursing Health Professions, Georgia State University, GA, Atlanta, United States.
    Chen Wong, Diana
    NYU Steinhardt, Department of Occupational Therapy, New York University, New York, United States.
    Tanveer, Sarah
    Department of Pharmaceutical Health Services Research, University of Maryland, MD, Baltimore, United States.
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    An overview of systematic reviews on the pharmacological randomized controlled trials for reducing intracranial pressure after traumatic brain injury2022In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 36, no 7, p. 829-840Article, review/survey (Refereed)
    Abstract [en]

    Background: There is a need for an overview of systematic reviews (SRs) examining randomized clinical trials (RCTs) of pharmacological interventions in the treatment of intracranial pressure (ICP) post-TBI.

    Objectives: To summarize pharmacological effectiveness in decreasing ICP in SRs with RCTs and evaluate study quality.

    Methods: Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, PsycINFO, and Cochrane Library databases for English SRs through October 2020. Inclusion criteria were SRs with RCTs that examined pharmacological interventions to treat ICP in patients post-TBI. Data extracted were participant characteristics, pharmacological interventions, and ICP outcomes. Study quality was assessed with AMSTAR-2.

    Results: Eleven SRs between 2003 and 2020 were included. AMSTAR-2 ratings revealed 3/11 SRs of high quality. Pharmacological interventions included hyperosmolars, neuroprotectives, anesthetics, sedatives, and analgesics. Study samples ranged from 7 to 1282 patients. Hyperosmolar agents and sedatives were beneficial in lowering elevated ICP. High bolus dose opioids had a more deleterious effect on ICP. Neuroprotective agents did not show any effects in ICP management. RCT sample sizes and findings in the SRs varied. A lack of detailed data syntheses was noted. AMSTAR-2 analysis revealed moderate-to-high quality in most SRs. Future SRs may focus on streamlined reporting of dosing and clearer clinical recommendations.

    Conclusions: PROSPERO-Registration: CRD42015017355.

  • 8. Kim, Sonya
    et al.
    Mortera, Marianne
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Krishnan, Shilpa
    Hoffecker, Lilian
    Herrold, Amy
    Terhorst, Lauren
    King, Laurie
    Machtinger, Joseph
    Zumsteg, Jennifer M.
    Negm, Ahmed
    Heyn, Patricia
    Overview of pharmacological interventions after traumatic brain injuries: impact on selected outcomes2019In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, no 4, p. 442-455Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to conduct an overview of systematic reviews (SRs) to appraise the published evidence related to pharmacological interventions after traumatic brain injury (TBI). Searches were conducted with Medline, Embase, PsycINFO, Web of Science, PubMed. 780 retrieved SRs underwent a two-level screening to determine inclusion. Data extracted included participant characteristics, TBI severity, study design, pharmacological interventions, and outcomes. SRs were assessed for methodological quality by using the AMSTAR measurement tool. After removing duplicates, 166/780 SRs published between 1990-2017 were reviewed, 62 of which met inclusion criteria. More than 90 drugs and 22 substance-classes were extracted. Most medications were administered during the acute stage. Mild TBI was included in 3% of the SRs. Physiological outcomes comprised 45% of the SRs, primarily mortality. Activities of daily living (ADLs) outcomes constituted 22% of the SRs followed by cognition (13%) and psychological/behavioral outcomes (13%). Only 7% of the SRs assessed adverse events. Inconsistencies in definitions, methods, and heterogeneity of instruments used to measure treatment response were noted. Only a third of the SRs had high methodological quality. Most SRs had heterogeneous TBI samples, outcomes, or methodologies making it difficult to synthesize findings into recommended guidelines. This study demonstrated a need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI. PROSPERO Registration: CRD42015017355.

  • 9.
    Koskinen, Lars-owe
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Naredi, Silvana
    Olivecrona, Magnus
    Ten-year follow-up of patients in a double blinded randomized study on prostacyclin treatment in severe traumatic brain injury2017In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 31, no 6-7, p. 770-771Article in journal (Other academic)
  • 10.
    Magnusson, Beatrice M.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Isaksson, Emil
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Koskinen, Lars-Owe D.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    A prospective observational cohort study of traumatic brain injury in the northern region of Sweden2022In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 36, no 2, p. 191-198Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Generally, to map epidemiological and demographic features of patients with traumatic brain injury (TBI) in Umeå county, Sweden. Specifically, to evaluate the subjects needing a computed tomography (CT) of the head after suffering from TBI and frequencies of 1) intracranial lesions detected with CT, 2) need for neurosurgical intervention and 3) admission to hospital.

    METHODS: Patients with a suspected TBI, undergoing CT within 24 hours of arrival to hospital, were included in a database for evaluation.

    RESULTS: Out of 302 patients (63% male), 83% were GCS 13-15, 7% were GCS 9-12 and 10% were GCS <9. The frequency of abnormal CT findings was 23% in GCS 13-15, 67% in GCS 9-12 and 97% in GCS <9. Neurosurgical intervention was needed by 4% of those with GCS 13-15, 52% of those with GCS 9-12 and by 76% of those with GCS <9.

    CONCLUSIONS: Subjects with GCS 13-15  had higher frequencies of abnormal CT findings, need for neurosurgical intervention and hospital admission than previously reported. A similar trend was observed for patients with GCS 9-12, which can be of serious nature, with a higher frequency of need for neurosurgical intervention than previously described.

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  • 11. Matuseviciene, Giedre
    et al.
    Borg, Jörgen
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ulfarsson, Trandur
    de Boussard, Catharina
    Early intervention for patients at risk for persisting disability after mild traumatic brain injury: A randomized, controlled study2013In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 27, no 3, p. 318-324Article in journal (Refereed)
    Abstract [en]

    Study objective: To investigate the effect of an early intervention visit in addition to written information and treatment as usual for patients with an estimated high risk for persisting disability after a mild traumatic brain injury (MTBI). Research design: Randomized controlled trial. Methods: One hundred and seventy-three patients, aged 15-70 years with a Glasgow Coma Scale of 14-15 were included. All received written information about MTBI. Ninety-seven patients who reported three or more symptoms according to the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 10 days after the injury were considered as high-risk patients and were randomized to either early visit to a doctor or to treatment as usual (TAU); all patients including the 76 low-risk patients were followed-up at 3 months. Completion rate was 83%. Outcome measures included RPQ and the Hospital Anxiety and Depression Scale. Results: RPQ symptoms decreased significantly in both randomized groups, but were not significantly different in the groups at 3 months. At 3 months, anxiety and depression scores did not differ between groups. Conclusions: An early intervention, offered to patients with an estimated high risk for persisting disability, had no additional effect on symptom level at 3 months after MTBI as compared to TAU.

  • 12. Nygren-DeBoussard, Catharina
    et al.
    Godbolt, Alison
    Stenberg, Maud
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ulfarsson, Trandur
    Lindgren, Marie
    Karlsdottir, Gudrun
    Borg, Jorgen
    Trajectories of Recovery and Outcome after Severe Traumatic Brain Injury: Design and baseline data from the "PROBRAIN" study2012In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, no 4-5, p. 560-561Article in journal (Other academic)
  • 13.
    Olivecrona, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Rodling-Wahlstrom, Marie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Naredi, Silvana
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Koskinen, Lars-Owe D.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Prostacyclin treatment and clinical outcome in severe traumatic brain injury patients managed with an ICP-targeted therapy: A prospective study2012In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, no 1, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Objective: To prospectively assess clinical outcome in patients with severe traumatic brain injury (sTBI) managed according to an ICP-targeted programme as well as additional treatment with prostacyclin.

    Materials and methods: Inclusion criteria were GCS <= 8, age 15-70 years, first recorded cerebral perfusion pressure (CPP)>10mmHg. Exclusion criteria were pregnancy, breastfeeding or penetrating brain injury. The patients were treated using the same ICP-guided protocol, with one group randomized to receive prostacyclin in a low dose (0.5 ng kg(-1) min(-1)). The clinical outcome was prospectively assessed at 3, 6, 12, 18 and 24 months using structured interviews.

    Results: Forty-eight patients were included, mean age 35.5 years, median GCS 6 (3-8), 69% were multi-traumatized. Mortality at 3 months was 12.5%. Median Glasgow Outcome Scale (GOS) at all follow-up points was 4. Favourable outcome (GOS 4-5) at 3 months was 52%, at 24 months 64%. Favourable outcome increased over time. There was a statistically significant association between GOS, GCS at admission and age. Higher ICP(max) was associated with worse outcome.

    Conclusion: With this treatment protocol, a low number of deaths and a high number of favourable outcomes in sTBI were observed. Prostacyclin in this low dose does not seem to improve the outcome. ICP(max) is a positive predictor of worse outcome. Higher GCS at admission and lower age are correlated to better outcome.

  • 14.
    Olivecrona, Zandra
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Bobinski, Lukas
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Koskinen, Lars-Owe D.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Association of ICP, CPP, CT findings and S-100B and NSE in severe traumatic head injury. Prognostic value of the biomarkers2015In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 29, no 4, p. 446-454Article in journal (Refereed)
    Abstract [en]

    Objective: The association was studied of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) on S-100B and neuron-specific enolase (NSE) in severe traumatic brain injury (sTBI). The relationship was explored between biomarkers, ICP, CPP, CT-scan classifications and the clinical outcome.

    Materials and methods: Data were collected prospectively and consecutively in 48 patients with Glasgow Coma Scale score ≤ 8, age 15–70 years. NSE and S-100B were analysed during 5 consecutive days. The initial and follow-up CT-scans were classified according to the Marshall, Rotterdam and Morris-Marshall classifications. Outcome was evaluated with extended Glasgow outcome scale at 3 months.

    Results: Maximal ICP and minimal CPP correlated with S-100B and NSE levels. Complex relations between biomarkers and CT classifications were observed. S-100B bulk release (AUC = 0.8333, p = 0.0009), and NSE at 72 hours (AUC = 0.8476, p = 0.0045) had the highest prediction power of mortality. Combining Morris-Marshall score and S-100B bulk release improved the prediction of clinical outcome (AUC = 0.8929, p = 0.0008).

    Conclusion: Biomarker levels are associated with ICP and CPP and reflect different aspects of brain injury as evaluated by CT-scan. The biomarkers might predict mortality. There are several pitfalls influencing the interpretation of biomarker data in respect to ICP, CPP, CT-findings and clinical outcome.

  • 15.
    Renström, Barbro
    et al.
    Kolbäcken Child Rehabilitation Centre, Umeå.
    Söderman, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Emanuelson, Ingrid
    Univ Gothenburg, Dept Pediat, Inst Clin Sci, Gothenburg, Sweden.
    Self-reported health and influence on  life  situation 5–8 years after paediatric traumatic brain injury2012In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, no 12, p. 1405-1414Article in journal (Refereed)
    Abstract [en]

    Primary objective : During childhood, the central nervous system is in a state of rapid development which can be interrupted by a traumatic brain injury (TBI). This study aimed to describe if and how TBI during childhood influences health and life situation, 5–8 years later.

    Research design : A case-control retrospective design was employed for the assessment of 61 adolescents and young adults with a mild, moderate or severe TBI and 229 matched controls from a normative group (16–24 years).

    Methods and procedures : SF-36 (Short Form 36 health survey) and a self-reported questionnaire measuring life situation were distributed to youths suffering TBI 5–8 years ago. Forty-five youths (74%) completed the questionnaires.

    Main outcomes and results : Participants with a TBI stated lower self-estimated health compared with the normative group.

    Remaining self-reported symptoms were physical and cognitive. Negative effects of TBI influencing school results, leisure activities and thoughts about future life situation were also described.

    Conclusion : Young individuals experience sustained negative effects of childhood TBI on health and life situation. More research is necessary to detect, understand and properly support these youths.

  • 16.
    Sojka, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Karlsson, Kurt
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    One-year follow-up of patients with mild traumatic brain injury: occurrence of post-traumatic stress-related symptoms and serum levels of cortisol, S-100B and neuron-specific enolase in acute phase2006In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 20, no 6, p. 613-620Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate serum levels of cortisol (a biochemical marker of stress), S-100B and neuron-specific enolase (two biochemical markers of brain tissue injury), in acute phase in mild traumatic brain injury patients and the occurrence of post-traumatic stress-related symptoms 1 year after the trauma.

    METHODS: Blood samples were taken in patients (n = 88) on admission and approximately 7 hours later for analysis. Occurrence of post-traumatic stress-related symptoms was assessed for 69 patients using items from the Impact of Event Scale questionnaire (IES) at follow-up at 15 +/- 4 months after the injury.

    RESULTS: Serum levels of cortisol were more increased in the first sample (cortisol/1, 628.9 +/- 308.9 nmol L-1) than in the second blood sample (cortisol/2, 398.2 +/- 219.4 nmol L-1). The difference between these samples was statistically significant (p < 0.001). Altogether 12 patients (17%) showed post-traumatic stress related symptoms at the time of the follow-up. Stepwise forward logistic regression analysis of symptoms and serum concentrations of markers revealed that only S-100B in the second sample was statistically significantly (p < 0.05) associated to symptoms (three symptoms of the avoidance sub-set of IES).

    CONCLUSION: A major increase in serum concentrations of cortisol indicates that high stress levels were reached by the patients, in particular shortly ( approximately 3 hours) after the trauma. The association between the occurrence of post-traumatic stress related symptoms and serum levels of S-100B (generally considered as a biochemical marker of brain injury) seem to reflect the complexity of interactions between brain tissue injury and the ensemble of stress reactions.

  • 17.
    Stenberg, Maud
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Koskinen, Lars-Owe D
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Jonasson, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Levi, Richard
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Clinical Sciences, Danderyd University Hospital, Division of Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Computed tomography and clinical outcome in patients with severe traumatic brain injury2017In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 31, no 3, p. 351-358Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI).

    METHODS: Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated.

    RESULTS: Thirty-seven patients were included. Marshall CTi and CT24 were significantly correlated with RLAS-R at three months. Rotterdam CT24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year.

    CONCLUSION: Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.

  • 18.
    Stenberg, Maud
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family Illness Trajectory During Seven Years After A Severe Traumatic Brain Injury-Family Interviews2019In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, p. 147-147Article in journal (Other academic)
  • 19.
    Stenberg, Maud
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Long-Term Follow-Up Observation Study 7 Years after Severe Traumatic Brain Injury in Northern Sweden2019In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, p. 161-161Article in journal (Other academic)
  • 20. Ström, J O
    et al.
    Boström, S
    Bobinski, Lukas
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Theodorsson, A
    Low-grade infection complicating silastic dural substitute 32 years post-operatively2011In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 25, no 2, p. 250-254Article in journal (Refereed)
    Abstract [en]

    Background: A complication of a silastic dural substitute is described, which appeared after 32 years-by far the longest latency period reported in the literature. Methods: Case report and literature review. Results: In 1971, a 20-year old woman suffered from an acute subdural haematoma and a temporal cerebral contusion due to a motorbike accident. She underwent an operation with evacuation of these and the dura was mended with a silastic duraplasty. Thirty-two years later she deteriorated with increased memory problems and dysphasia. CT revealed an expanding haemorrhagic mass around the previous duraplasty, which demanded surgery with removal of the silastic dural implant and evacuation of the haemorrhagic mass. Although the haemorrhagic mass enveloped the silastic implant, a contribution of the acrylate flap cannot be ruled out. Bacteriological cultures revealed Acinetobacter spp. in the CSF. Adequate post-operative antibiotic treatment was administered. The patient slowly improved, but the complication represented a major setback in her long-term cognitive and communicative functions. Conclusions: This case widens the previously reported time-frame of late complications by 60%, from 20 to 32 years, and will hopefully serve to increase the awareness of late infections and haemorrhages induced by silastic dural implants, thereby improving diagnosis and treatment in future cases.

  • 21.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury2007In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 21, no 9, p. 933-942Article in journal (Refereed)
    Abstract [en]

    PRIMARY OBJECTIVE: To investigate the relation between psychosocial functioning (community integration, life satisfaction and social support) and symptoms (post-concussion, post-traumatic stress and depression) in persons with mild traumatic brain injury (MTBI) 3 years after the trauma.

    METHODS: Population-based follow-up study of 163 patients. At follow-up, an assessment of community integration, social support, life satisfaction and symptoms was made.

    RESULTS: Total score of Community Integration Questionnaire (CIQ) was negatively correlated to total score of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ, r = -0.270, p < 0.001) and to total score of the Beck Depression Inventory (BDI, r = -0.332, p < 0.001). Life satisfaction (LiSat-11) was negatively correlated to the RPQ (r = -0.459, p < 0.001), to total score of the Impact of Event Scale (IES, r = -0.365, p < 0.001) and to the BDI (r = -0.642, p < 0.001). Low levels of life satisfaction were common at follow-up.

    CONCLUSIONS: A large proportion of the individuals with MTBI experienced both psychosocial difficulties, with low levels of life satisfaction in particular and symptoms (post-concussion, post-traumatic stress and depression) 3 years after trauma. Since the possibility of pre-injury factors contributing to the condition at follow-up cannot be ruled out, the study indicates that all these factors should be taken into consideration in the management of persons with MTBI.

  • 22.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Tegner, Yelverton
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sojka, Peter
    Winternet, Institution of Health Sciences, Luleå University of Technology, Boden, Sverige.
    Playing soccer increases serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase in elite players: a pilot study2004In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 18, no 9, p. 899-909Article in journal (Refereed)
    Abstract [en]

    Primary objective : To analyse serum concentrations of two biochemical markers of brain tissue damage, S-100B and NSE (neurone-specific enolase), in male soccer players in connection to the game. Methods : Blood samples were taken in players before and after a competitive game and the numbers of headers and of trauma events during soccer play were assessed. Results : Both S-100B and NSE were significantly raised in serum samples obtained after the game in comparison with the pre-game values (S-100B: 0.118 ± 0.040 µg L -1 vs 0.066 ± 0.025 µg L -1 , p < 0.001; NSE: 10.29 ± 2.16 µg L -1 vs 8.57 ± 2.31 µg L -1 , p < 0.001). Only changes in S-100B concentrations (post-game minus pre-game values) were statistically significantly correlated to the number of headers ( r = 0.428, p = 0.02) and to the number of other trauma events ( r = 0.453, p = 0.02). Conclusion : Playing competitive elite soccer was found to cause increase in serum concentrations of S-100B and NSE. Increases in S-100B were significantly correlated to the number of headers, and heading may accordingly have contributed to these increases.

  • 23.
    Sundström, Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nilsson, Lars-Göran
    Department of Psychology, Stockholm University.
    Cruts, M.
    Depatrment of Molecular Genetics, Flanders Interuniversity Institute for Biotechnology, University of Antwerp, Belgium.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nyberg, Lars
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    van Broeckhoven, C.
    Depatrment of Molecular Genetics, Flanders Interuniversity Institute for Biotechnology, University of Antwerp, Belgium.
    Fatigue before and after mild traumatic brain injury: Pre-post-injury comparisons in relation to Apolipoprotein E2007In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 21, no 10, p. 1049-1054Article in journal (Refereed)
    Abstract [en]

    Primary objective: To assess the incidence of fatigue for persons following a mild traumatic brain injury (MTBI) and to evaluate the relationship between fatigue and APOE genotype. As fatigue is often found to be influenced by anxiety, depression and sleep disturbance, these factors were also measured. Methods and procedures: Thirty-one persons who sustained a MTBI were drawn from a population-based longitudinal study. Each person who sustained a MTBI was matched by age, gender, education and APOE genotype with two non-head injury controls. Self-reported pre- and post-injury incidence of fatigue, anxiety, depression and sleep disturbance was compared within-group and between groups. Results: For the MTBI group, incidence of fatigue was almost twice as common post- than pre-injury, whereas there was no corresponding change in a non-injured control group. Within the MTBI-group, post-injury fatigue was particularly common for carriers of the APOE ε4 allele. Conclusions: Fatigue is common sequela after a MTBI and especially pronounced for carriers of the APOE ε4 allele.

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