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Clinical Advances in Traumatic Brain Injury
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Clinical Advances in Traumatic Brain Injury

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 4287

Special Issue Editor

Dr. Abhijit V. Lele

E-Mail Website
Guest Editor
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
Interests: traumatic brain injury; critical care; anesthesiology

Special Issue Information

Dear Colleagues,

Traumatic brain injury (TBI) is a global public health problem. Every year, over 69 million TBI cases are reported worldwide. TBI affects patients in high- and low–middle-income countries and across different age groups. Despite decades of research, guidelines and recommendations, several questions remain unanswered:

  1. What is the optimal management of care for patients with TBI? Are we providing care concordant with the latest evidence, guidelines and recommendations?
  2. How can we advance the care of patients with TBI in resource-limited clinical settings? What are the challenges in adapting guidelines across different resource settings?
  3. Are we providing safe, effective, patient-centered, timely, efficient and equitable care to our patients with TBI?
  4. What are the principles of TBI care in the emergency room, the intensive care unit and the operating room? How similar or different are these?
  5. What is the role of multimodal monitoring?
  6. What are the advances in neuro prognostication after TBI? There is continued interest in when and how we should prognosticate. What direction does the evidence point us to?

In this Special Issue, we aim to discuss these areas and invite a broad panel of experts to contribute.

Dr. Abhijit V. Lele
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • traumatic brain injury
  • guideline/recommendations
  • concordant care
  • resource limited clinical setting
  • multimodal monitoring
  • neuroprognostication
  • safe/effective/patient-centered/timely/efficient/equitable care
  • quality improvement

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Published Papers (3 papers)

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Research

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13 pages, 677 KiB  
Article
Good Health-Related Quality of Life in Older Patients One Year after mTBI despite Incomplete Recovery: An Indication of the Disability Paradox?
by Sophie M. Coffeng, Amaal Eman Abdulle, Harm J. van der Horn, Myrthe E. de Koning, Jan C. ter Maaten, Jacoba M. Spikman and Joukje van der Naalt
J. Clin. Med. 2024, 13(9), 2655; https://doi.org/10.3390/jcm13092655 - 1 May 2024
Viewed by 819
Abstract
Background: Older adults (OAs) with mild traumatic brain injury (OA-mTBI) are a growing population, but studies on long-term outcomes and quality of life are scarce. Our aim was to determine the health-related quality of life (HRQoL) in OA-mTBI one year after injury [...] Read more.
Background: Older adults (OAs) with mild traumatic brain injury (OA-mTBI) are a growing population, but studies on long-term outcomes and quality of life are scarce. Our aim was to determine the health-related quality of life (HRQoL) in OA-mTBI one year after injury and to assess the early predictors of HRQoL. Methods: Data from a prospective follow-up study of 164 older (≥60 years) and 289 younger mTBI patients (<60 years) admitted to the emergency department were analyzed. Post-traumatic complaints, emotional distress and coping were evaluated 2 weeks post-injury using standardized questionnaires. At 12 months post-injury, HRQoL and functional recovery were determined with the abbreviated version of the World Health Organization Quality of Life scale and Glasgow Outcome Scale Extended (GOSE), respectively. Results: One year post-injury, 80% (n = 131) of the OA-mTBI rated their HRQoL as “good” or “very good”, which was comparable to younger patients (79% (n = 226), p = 0.72). Incomplete recovery (GOSE <8) was present in 43% (n = 69) of OA-mTBI, with 67% (n = 46) reporting good HRQoL. Two weeks post-injury, fewer OA-mTBI had (≥2) post-traumatic complaints compared to younger patients (68% vs. 80%, p = 0.01). In the multivariable analyses, only depression-related symptoms (OR = 1.20 for each symptom, 95% CI = 1.01–1.34, p < 0.01) were predictors of poor HRQoL in OA-mTBI. Conclusions: Similar to younger patients, most OA-mTBI rated their HRQoL as good at one year after injury, although a considerable proportion showed incomplete recovery according to the GOSE, suggesting a disability paradox. Depression-related symptoms emerged as a significant predictor for poor HRQoL and can be identified as an early target for treatment after mTBI. Full article
(This article belongs to the Special Issue Clinical Advances in Traumatic Brain Injury)
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15 pages, 1830 KiB  
Article
Early Cardiac Evaluation, Abnormal Test Results, and Associations with Outcomes in Patients with Acute Brain Injury Admitted to a Neurocritical Care Unit
by Abhijit V. Lele, Jeffery Liu, Thitikan Kunapaisal, Nophanan Chaikittisilpa, Taniga Kiatchai, Michael K. Meno, Osayd R. Assad, Julie Pham, Christine T. Fong, Andrew M. Walters, Koichiro Nandate, Tumul Chowdhury, Vijay Krishnamoorthy, Monica S. Vavilala and Younghoon Kwon
J. Clin. Med. 2024, 13(9), 2526; https://doi.org/10.3390/jcm13092526 - 25 Apr 2024
Viewed by 1575
Abstract
Background: to examine factors associated with cardiac evaluation and associations between cardiac test abnormalities and clinical outcomes in patients with acute brain injury (ABI) due to acute ischemic stroke (AIS), spontaneous subarachnoid hemorrhage (SAH), spontaneous intracerebral hemorrhage (sICH), and traumatic brain injury (TBI) [...] Read more.
Background: to examine factors associated with cardiac evaluation and associations between cardiac test abnormalities and clinical outcomes in patients with acute brain injury (ABI) due to acute ischemic stroke (AIS), spontaneous subarachnoid hemorrhage (SAH), spontaneous intracerebral hemorrhage (sICH), and traumatic brain injury (TBI) requiring neurocritical care. Methods: In a cohort of patients ≥18 years, we examined the utilization of electrocardiography (ECG), beta-natriuretic peptide (BNP), cardiac troponin (cTnI), and transthoracic echocardiography (TTE). We investigated the association between cTnI, BNP, sex-adjusted prolonged QTc interval, low ejection fraction (EF < 40%), all-cause mortality, death by neurologic criteria (DNC), transition to comfort measures only (CMO), and hospital discharge to home using univariable and multivariable analysis (adjusted for age, sex, race/ethnicity, insurance carrier, pre-admission cardiac disorder, ABI type, admission Glasgow Coma Scale Score, mechanical ventilation, and intracranial pressure [ICP] monitoring). Results: The final sample comprised 11,822 patients: AIS (46.7%), sICH (18.5%), SAH (14.8%), and TBI (20.0%). A total of 63% (n = 7472) received cardiac workup, which increased over nine years (p < 0.001). A cardiac investigation was associated with increased age, male sex (aOR 1.16 [1.07, 1.27]), non-white ethnicity (aOR), non-commercial insurance (aOR 1.21 [1.09, 1.33]), pre-admission cardiac disorder (aOR 1.21 [1.09, 1.34]), mechanical ventilation (aOR1.78 [1.57, 2.02]) and ICP monitoring (aOR1.68 [1.49, 1.89]). Compared to AIS, sICH (aOR 0.25 [0.22, 0.29]), SAH (aOR 0.36 [0.30, 0.43]), and TBI (aOR 0.19 [0.17, 0.24]) patients were less likely to receive cardiac investigation. Patients with troponin 25th–50th quartile (aOR 1.65 [1.10–2.47]), troponin 50th–75th quartile (aOR 1.79 [1.22–2.63]), troponin >75th quartile (aOR 2.18 [1.49–3.17]), BNP 50th-75th quartile (aOR 2.86 [1.28–6.40]), BNP >75th quartile (aOR 4.54 [2.09–9.85]), prolonged QTc (aOR 3.41 [2.28; 5.30]), and EF < 40% (aOR 2.47 [1.07; 5.14]) were more likely to be DNC. Patients with troponin 50th–75th quartile (aOR 1.77 [1.14–2.73]), troponin >75th quartile (aOR 1.81 [1.18–2.78]), and prolonged QTc (aOR 1.71 [1.39; 2.12]) were more likely to be associated with a transition to CMO. Patients with prolonged QTc (aOR 0.66 [0.58; 0.76]) were less likely to be discharged home. Conclusions: This large, single-center study demonstrates low rates of cardiac evaluations in TBI, SAH, and sICH compared to AIS. However, there are strong associations between electrocardiography, biomarkers of cardiac injury and heart failure, and echocardiography findings on clinical outcomes in patients with ABI. Findings need validation in a multicenter cohort. Full article
(This article belongs to the Special Issue Clinical Advances in Traumatic Brain Injury)
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Review

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17 pages, 623 KiB  
Review
Severe Traumatic Brain Injury and Pulmonary Embolism: Risks, Prevention, Diagnosis and Management
by Charikleia S. Vrettou, Effrosyni Dima, Nina Rafailia Karela, Ioanna Sigala and Stefanos Korfias
J. Clin. Med. 2024, 13(15), 4527; https://doi.org/10.3390/jcm13154527 - 2 Aug 2024
Viewed by 1277
Abstract
Severe traumatic brain injury (sTBI) is a silent epidemic, causing approximately 300,000 intensive care unit (ICU) admissions annually, with a 30% mortality rate. Despite worldwide efforts to optimize the management of patients and improve outcomes, the level of evidence for the treatment of [...] Read more.
Severe traumatic brain injury (sTBI) is a silent epidemic, causing approximately 300,000 intensive care unit (ICU) admissions annually, with a 30% mortality rate. Despite worldwide efforts to optimize the management of patients and improve outcomes, the level of evidence for the treatment of these patients remains low. The concomitant occurrence of thromboembolic events, particularly pulmonary embolism (PE), remains a challenge for intensivists due to the risks of anticoagulation to the injured brain. We performed a literature review on sTBI and concomitant PE to identify and report the most recent advances on this topic. We searched PubMed and Scopus for papers published in the last five years that included the terms “pulmonary embolism” and “traumatic brain injury” in their title or abstract. Exclusion criteria were papers referring to children, non-sTBI populations, and post-acute care. Our search revealed 75 papers, of which 38 are included in this review. The main topics covered include the prevalence of and risk factors for pulmonary embolism, the challenges of timely diagnosis in the ICU, the timing of pharmacological prophylaxis, and the treatment of diagnosed PE. Full article
(This article belongs to the Special Issue Clinical Advances in Traumatic Brain Injury)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Patterns of Brain Injury and Clinical Outcomes Related to Trauma from Motor Vehicle Collisions
Authors: Bharti Sharma; Aubrey May B. Agcon; George Agriantonis; Samantha R Kiernan; Navin D. Bhatia; Kate Twelker; Zahra Shafaee; Jennifer Whittington
Affiliation: 1 Department of Surgery, NYC Health & Hospitals/Elmhurst, Queens, NY 2 Icahn School of Medicine at Mount Sinai Hospital, New York, NY
Abstract: Background: Despite improvements in technology and safety measures, injuries from motor vehicle collisions (MVCs) continue to be prevalent. Therefore, our goal is to investigate the different patterns of head injuries associated with MVCs. Method: This is a single-center, retrospective study of patients with motor vehicle-related trauma between January 1, 2016- December 31, 2023, inclusive. Patients were identified based on the International Classification of Diseases (ICD) injury codes and the Abbreviated Injury Severity (AIS) for body region involvement. Result: 536 patients met the inclusion criteria. The majority of the injured population includes pedestrians (46.8%) followed by motorcycle drivers (25.2%), bicyclists (18.7%), and motor vehicle drivers (9.3%). The male-to-female ratios for bicyclists and motorcyclists were 13.7:1 and 11.9:1, respectively, which is higher compared to motor vehicle occupants and pedestrians, with ratios of 2.3:1 and 1.5:1. Patients with blunt trauma (99.63%) were higher than penetrating trauma (0.37%). In most cases, the head had the highest AIS score, with a mean of 3.7. Additionally, the median Injury Severity Score (ISS) was 20. Skull fractures were the most prevalent, followed by hemorrhages, lacerations, contusions, and abrasions. The analysis using the Phi coefficient suggested that patients who experience cerebral hemorrhage are somewhat likely also to have cerebellar hemorrhage. Conclusion: The most prevalent injuries were head injuries and fractures. Fractures were the most common, followed by hemorrhage, laceration, contusion, and abrasion. These findings underscore the high incidence of TBI and fractures in such MVCs, highlighting the need for targeted trauma interventions and the need for injury prevention strategies to mitigate these severe outcomes.

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