Journal of Head Trauma Rehabilitation最新文献

{"title":"Development and Evaluation of Sleep Disorder Decision Aids for Veterans With Mild Traumatic Brain Injury.","authors":"Adam R Kinney, Lisa A Brenner, Morgan Nance, Audrey D Cobb, Jeri E Forster, Christi S Ulmer, Risa Nakase-Richardson, Constance H Fung, Nazanin H Bahraini","doi":"10.1097/HTR.0000000000001097","DOIUrl":"10.1097/HTR.0000000000001097","url":null,"abstract":"<p><strong>Objective: </strong>First, to summarize the design of novel decision aid prototypes aimed at facilitating shared decision-making for Veterans with co-morbid mild traumatic brain injury (mTBI) and sleep disorders (insomnia, obstructive sleep apnea [OSA]) in the Veterans Health Administration (VHA) Polytrauma/TBI System of Care (PSC). Second, to elicit feedback regarding usability, acceptability, and feasibility of prototypes to inform future implementation.</p><p><strong>Setting: </strong>Nationwide VHA PSC sites.</p><p><strong>Participants: </strong>Clinicians included VHA providers involved in the management of mTBI and/or sleep disorders in the VHA PSC (n = 7). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and OSA within the past year (n = 5).</p><p><strong>Design: </strong>Convergent parallel mixed methods.</p><p><strong>Main measures: </strong>Semi-structured interview guides; System Usability Scale; Ottawa Decision Aid Acceptability Scale.</p><p><strong>Results: </strong>Participants found the decision aid prototypes easy to use, highlighting its accessibility and features enabling an easy comparison of treatments. However, participants recommended changes to simplify and improve the design. Decision aids were seen as acceptable, providing essential information for Veterans with mTBI and facilitating shared decision-making among providers, Veterans, and other decision partners (eg, spouse). Removal of non-essential content was recommended to increase acceptability. Decision aids were considered feasible to implement, though extending the decision-making process beyond the initial encounter and accounting for time constraints were recommended.</p><p><strong>Conclusions: </strong>Findings highlight that the decision aids are easy-to-use, feasible to implement, and capable of improving Veteran-centered management of sleep disorders among those with mTBI. Nonetheless, clinicians and Veterans offered recommendations for changes that can improve the utility of the decision aids and facilitate their seamless integration into routine care for Veterans with co-morbid mTBI and sleep disorders. Findings lay the foundation for efforts aimed at implementing the decision aids into routine care for sleep disorders in the VHA PSC, aligning care decisions with Veteran preferences and improving outcomes.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Relationship Between Chronic Pain and Cognition: A NIDILRR and VA TBI Model Systems Collaborative Project.","authors":"Mackenzie Peckham, Cynthia L Beaulieu, Kaitlin Hays, Marissa Lundstern, Bria MacIntyre, Candice Osborne, Amanda Rabinowitz, Allan L Service, Mitch Sevigny, Katherine Abbasi, William C Walker, Abigail Welch, Candace Tefertiller","doi":"10.1097/HTR.0000000000001045","DOIUrl":"10.1097/HTR.0000000000001045","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the associations between current chronic pain and cognition and current chronic head pain and cognition in individuals with traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>A total of 1762 participants from the TBI Model Systems who endorsed experiencing current chronic pain and who completed the Current Chronic Pain survey.</p><p><strong>Design: </strong>Secondary analysis of a subset of data collected through a multi-site, cross-sectional observational cohort study.</p><p><strong>Main outcome measures: </strong>Cognition as measured by the Brief Test of Adult Cognition by Telephone (BTACT).</p><p><strong>Results: </strong>Individuals with TBI who reported current chronic pain exhibited lower cognitive performance compared to those who reported no pain. Among individuals who reported pain, greater pain intensity and pain interference were negatively associated with cognition, resulting in poorer cognitive performance. The negative association was even greater for individuals acknowledging chronic head pain compared to pain from other body locations.</p><p><strong>Conclusion: </strong>The negative association between current chronic pain and cognition for individuals with TBI indicates the need to consider pain intensity and pain interference as factors possibly influencing cognitive ability.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"356-367"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Lagged Associations Among Sleep, Headache, and Pain in Pediatric Mild Traumatic Brain Injury: An A-CAP Study.","authors":"Safira Dharsee, Ali Hassan, Melanie Noel, Amy M Bender, Miriam H Beauchamp, William Craig, Quynh Doan, Stephen B Freedman, Jocelyn Gravel, Roger Zemek, Keith Owen Yeates","doi":"10.1097/HTR.0000000000001038","DOIUrl":"10.1097/HTR.0000000000001038","url":null,"abstract":"<p><strong>Objective: </strong>To test cross-lagged associations among sleep, headache, and pain in pediatric mild traumatic brain injury (mTBI).</p><p><strong>Setting, participants, design: </strong>Children and adolescents aged 8.0 to 16.9 years who sustained a mTBI and presented to 1 of 5 pediatric emergency departments across Canada completed assessments at 1-week, 3 months, and 6 months post-injury as part of a larger prospective cohort study.</p><p><strong>Main measures: </strong>Sleep disturbance was measured using 7 sleep items from the Child Behaviour Checklist. Sleep duration was measured using average weekday and weekend sleep from the Healthy Lifestyle Behaviours Questionnaire. Pain intensity was measured using an 11-point numerical rating scale. Headache severity and associated functional impairment were measured using the Headache Impact Test and 1 item from the Health and Behaviour Inventory. Analyses included trivariate-indicator random-intercept cross-lagged panel models.</p><p><strong>Results: </strong>Of 633 recruited children, 563 were included in the current study. Headache showed significant within-person, bidirectional, cross-lagged associations with sleep disturbance and duration, as well as with pain intensity. More specifically, worse headache predicted greater sleep disturbance (1-week to 3 months and 3 months to 6 months: B s = .47, P s ≤ .013) and shorter sleep duration (1-week to 3 months: B = -.21, P = .006), while greater sleep disturbance predicted worse headache (1-week to 3 months: B = .08, P = .001). Worse headache also predicted higher pain intensity (1-week to 3 months & 3 months to 6 months: B s ≥ 1.27, P s < .001), while higher pain intensity predicted worse headache (3 months to 6 months: B s ≥ .03, P s ≤ .042). No cross-lagged associations involving sleep disturbance or duration with pain intensity were significant.</p><p><strong>Conclusions: </strong>Significant bi-directional, cross-lagged associations exist between headache and both sleep and pain. The findings suggest that early intervention for headaches may help prevent later sleep disturbance and pain after pediatric mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"309-318"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Clinical Outcomes Associated With the Veterans Health Administration's Traumatic Brain Injury and Mental Health Screens.","authors":"Shannon R Miles, Peter A Toyinbo, Heather G Belanger, Hari H Venkatachalam, Stephen L Luther, Nina A Sayer","doi":"10.1097/HTR.0000000000001047","DOIUrl":"10.1097/HTR.0000000000001047","url":null,"abstract":"<p><strong>Objective: </strong>Examine if the mandated Veterans Affairs traumatic brain injury (TBI) screen is associated with long-term postconcussive symptoms as compared to how the mandated mental health (MH) screen is associated with long-term MH symptoms.</p><p><strong>Setting: </strong>Veterans Health Administration.</p><p><strong>Participants: </strong>Patients (N = 1628) who were previously screened for TBI with current postconcussive symptoms and MH conditions completed a survey assessing current postconcussive symptoms, depression, posttraumatic stress disorder, alcohol use, and physical and emotional well-being. Participants were mostly male (83%), less than 40 years old (38%), and identified as White (64%). Forty-five percent screened positive for MH conditions; 11% screened positive for TBI.</p><p><strong>Design: </strong>Cohort survey study of random sample of post-9/11 veterans combined with retrospective database analysis. Bayesian Network Analysis was used to compare how the TBI and MH screens related to long-term postconcussive and MH symptoms. The pathway on the Bayesian Network graph leading to postconcussive symptoms was thoroughly examined with a regression.</p><p><strong>Main measures: </strong>Neurobehavioral Symptom Inventory to measure postconcussive symptoms.</p><p><strong>Results: </strong>A Bayesian network arch demonstrated TBI screening was related to use of TBI services within 6 months after the screening but not related to long-term postconcussive or MH symptoms. In comparison, the MH screen led to post-screen MH services, postconcussive symptoms, and most of the other secondary outcomes, including posttraumatic stress disorder and depression. The regression model showed that a positive MH screen, more MH service use, negative life events, and moderate depression were associated with greater postconcussive symptoms years after screening.</p><p><strong>Conclusion: </strong>While both TBI and MH screening were associated with increased service use, only the MH screen was associated with long-term postconcussive symptoms. Findings raise questions about whether the TBI screening program adds value over and above the MH screening program.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E349-E359"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Clinical TBI Severity and Military Factors With Veteran TBI Service-Connected Disability Ratings and Total Compensation: A Long-Term Impact of Military Brain Injury Consortium (LIMBIC) Study.","authors":"Clara E Dismuke-Greer, Aryan Esmaeili, Mary Jo Pugh, Terri K Pogoda, Megan Amuan, David X Cifu","doi":"10.1097/HTR.0000000000001052","DOIUrl":"10.1097/HTR.0000000000001052","url":null,"abstract":"<p><strong>Objective: </strong>To understand how traumatic brain injury (TBI) clinical severity and military factors were associated with the likelihood of receiving a TBI service-connected disability (SCD) determination and monthly total SCD compensation among Veterans.</p><p><strong>Setting: </strong>Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA).</p><p><strong>Participants: </strong>1 319 590 veterans with a VBA SCD rating who entered the VHA between October 1, 2000, and September 24, 2019.</p><p><strong>Design: </strong>This retrospective study analyzed the association of TBI severity and military factors with a TBI SCD determination, TBI SCD rating percentage, and monthly total SCD compensation. Administrative VHA and VBA records were utilized.</p><p><strong>Main measures: </strong>Any TBI SCD determination, TBI SCD rating percentage, and monthly SCD compensation.</p><p><strong>Results: </strong>93 911 (7.1%) Veterans had an SCD rating for TBI. TBI SCD increased monthly total compensation by $362 (95% CI 353, 370) in bivariate and $45 (95% CI 38, 52) in adjusted models. Females had lower TBI SCD percentage (-3.03; 95% CI -3.92, -2.14) but higher monthly compensation ($37; 95% CI 33, 42). TBI severity was associated with increasing TBI SCD percentage and monthly SCD compensation. In adjusted models, deployment (-2.36; 95% CI -3.02, -1.69) was associated with lower TBI SCD percentage but not monthly compensation, while combat exposure was not associated with TBI SCD percentage but was associated with higher compensation ($46; 95% CI 40, 53).</p><p><strong>Conclusion: </strong>TBI severity was significantly associated with TBI SCD determination and TBI SCD rating percentage, in addition to overall SCD compensation. Although deployment was significantly associated with TBI SCD determination, non-deployment was associated with higher TBI SCD percent ratings. These results may be explained by TBI occurring in non-deployment military settings, such as training. This highlights the need to study risk for TBI in the general military environment to ensure that all military-related TBI exposures are recognized and that any related disability is appropriately compensated.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"368-377"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collegiate Participation in Repetitive Head Impact Sports Does Not Adversely Affect Gait Dual Task Cost.","authors":"Thomas A Buckley, Kristen Williams, Jessie R Oldham, Katherine J Hunzinger, Caitlin Gallo, Scott W Passalugo, Barry Bodt, Melissa N Anderson, Kelsey Bryk, Barry A Munkasy","doi":"10.1097/HTR.0000000000001051","DOIUrl":"10.1097/HTR.0000000000001051","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to assess gait related dual task cost (DTC) changes over the course of a collegiate athletic career in both repetitive head impact (RHI) exposed and non-RHI exposed athletes.</p><p><strong>Setting: </strong>University Research Laboratory.</p><p><strong>Participants: </strong>We recruited 47 NCAA intercollegiate athletes and grouped by RHI exposed (N = 27) and non-RHI (N = 20) sports.</p><p><strong>Design: </strong>Participants completed 5 trials of single task (ST) and 5 trials of dual task (DT) gait with a working memory cognitive challenge both prior to their collegiate athletic careers (pre) and then again after they completed their collegiate athletic careers (post) (mean 1173 ± 341 days between tests) in this prospective longitudinal design. To assess for changes over the course of a career, separate 2 (group: RHI, non-RHI) × 2 (time: pre, post) mixed design ANOVA were performed for each dependent variable of interest (DTC gait velocity and DTC step length) and the model was adjusted for concussion history at the time of test and sex.</p><p><strong>Main measures: </strong>Gait velocity and step length DTC.</p><p><strong>Results: </strong>There were no significant group by time interactions for DTC gait velocity (F = 0.517, P = .476, η 2 = 0.012) or DTC step length ((F = 0.206, P = .652, η 2 = 0.005).</p><p><strong>Conclusions: </strong>The primary finding of this study indicated no difference between RHI exposed and non-RHI exposed athletes gait DTC performance between the beginning and conclusion of their collegiate athletic careers. While the long-term effects of RHI remain to be fully determined, these results suggest that RHI may not adversely affect ST or DT gait performance when the individual is young.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"329-336"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video Head Impulse Test in Survivors From Severe Traumatic Brain Injury: New Perspectives for Implementation of Assessment in Rehabilitation.","authors":"Nicola Ferri, Susan L Whitney, Luca Verrecchia, Laura Casagrande Conti, Andrea Turolla, Tommaso Lelli, Rita Formisano, Maria Gabriella Buzzi, Paolo Pillastrini, Leonardo Manzari, Marco Tramontano","doi":"10.1097/HTR.0000000000001044","DOIUrl":"10.1097/HTR.0000000000001044","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate vestibular function by instrumental assessment of the angular vestibulo-ocular reflex (aVOR) in survivors from severe traumatic brain injury (sTBI) and analyze related clinical characteristics and functional balance scales.</p><p><strong>Setting: </strong>This study was conducted on inpatients accepted at Santa Lucia Foundation-Neurorehabilitation Hospital for Research and Healthcare (Rome, Italy), from January to September 2023.</p><p><strong>Participants: </strong>Twenty-one survivors from sTBI with a median age of 48 years (IQR = 27) were included in this study, recruited through the neurorehabilitation services. Participants were included if they had a Glasgow Coma Scale Score ≤ 8 at the time of injury, Level of Cognitive Functioning ≥ 7, static and dynamic balance impairments, ability to understand verbal commands, and Functional Ambulation Classification > 3.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Main measures: </strong>Two expert physiotherapists performed an aVOR assessment using the video Head ImpulseTest by both head impulse and suppression paradigms. Furthermore, all participants completed a balance assessment using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scale. Descriptive statistical analyses were performed, and the relationship between aVOR function and balance outcomes was investigated.</p><p><strong>Results: </strong>Nineteen participants (90%) displayed aVOR with an abnormal gain at least in 1 canal. Thirty percent of all canals analyzed had abnormal gains, with a clear prevalence of the right posterior canal (71%), which presents aVOR gain lower than the functional threshold on average (mean 0.70; CI, 0.62-0.78). No correlations were found between the aVOR gain and the clinical outcome measure scores.</p><p><strong>Conclusion: </strong>Low aVOR gains were evident in people who experienced sTBI. A comprehensive evaluation of the vestibular peripheral system may detect vestibular impairments in these patients that may otherwise be unrecognized.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"337-345"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reciprocal Causation Among Pain, Physical Health, and Mental Health 1 Year Post-Traumatic Brain Injury: A Cross-Lagged Panel Model From the TRACK-TBI Study.","authors":"Carly Wender, Paul B Perrin, Denise Krch","doi":"10.1097/HTR.0000000000000946","DOIUrl":"10.1097/HTR.0000000000000946","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the relative causal influence of physical and mental health on pain in persons with traumatic brain injury (TBI) within the year following injury.</p><p><strong>Setting: </strong>Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) was a multicenter study that collected data from 18 level 1 trauma centers around the United States.</p><p><strong>Participants: </strong>TRACK-TBI recruited adults who experienced an acute TBI. For this secondary analysis, participants were included if they endorsed pain during at least 1 follow-up within 1 year post-TBI.</p><p><strong>Design: </strong>Secondary analysis using structural equation modeling of the longitudinal TRACK-TBI dataset of an inception cohort.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes are pain, physical health, and mental health. Pain was measured by averaging the T-scores of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Pain Interference scales. Physical and mental health were measured with the raw component scores (physical component score and mental component score, respectively) on the Short Form Health Survey.</p><p><strong>Results: </strong>Eighty-nine percent of the TRACK-TBI cohort (n = 2022) reported pain throughout 1 year postinjury. This sample (n = 1796) was primarily white (77%) men (67%) in their early forties with mild (87%) closed head injuries (99%) related to motor or road vehicle accidents (57%). Based on the final trimmed model, there was a stronger dominance of pain on physical and mental health than physical and mental health on pain. Thus, pain is a bigger driver of physical and mental health than vice versa.</p><p><strong>Conclusions: </strong>Persistent pain is highly prevalent post-TBI and is a bigger driver of physical and mental health 1 year post-TBI than the other way round. Future research should aim to better understand the causes of pain post-TBI to inform what treatments are most effective at reducing pain intensity and interference post-TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"319-328"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Frailty, Comorbidities and Muscularity With GOS and 30-Day Mortality After TBI in Elderly Patients-A Retrospective Study in 1104 Patients.","authors":"Sebastian Niedermeyer, Thomas Weig, Mathias Leiber, Aylin Gencer, Sophia Stöcklein, Nicole A Terpolilli","doi":"10.1097/HTR.0000000000001020","DOIUrl":"10.1097/HTR.0000000000001020","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the prognostic value of various frailty assessment tools in predicting 30-day mortality and Glasgow outcome scale (GOS) at discharge in elderly patients with traumatic brain injury (TBI). Additionally, the study evaluated the role of muscularity as surrogate for frailty in the context of TBI.</p><p><strong>Setting: </strong>Data were collected from patients treated as inpatients in a single hospital.</p><p><strong>Participants: </strong>All patients aged 60 years or older who were admitted for TBI between 1/2010 and 12/2020.</p><p><strong>Design: </strong>A single-center study, with retrospective analysis of clinical notes and computed tomography (CT) imaging at admission.</p><p><strong>Mean measures: </strong>Assessment of frailty by different frailty grading scales, comorbidities by the Charlson Comorbidity Index (CCI), assessment of muscularity by muscle area measurements and their association with outcome of TBI.</p><p><strong>Results: </strong>A total of 1104 patients with a median age of 78 years (IQR 72-84) were identified. The overall mortality rate was 12.9% (n = 137). Multivariate regression models identified frailty measured by the Clinical Frailty Scale (CFS) ( P < .0001) as predictive variable for short-term mortality and the CCI as predictive variable for GOS at discharge ( P = .009); muscle area measurements as surrogate markers of sarcopenia were not associated with outcome in our cohort. Implementing frailty as measured by CFS and CCI into prognostic models for short-term mortality increased their predictive power (increase of area under the ROC curve from 0.897 to 0.919).</p><p><strong>Conclusions: </strong>Geriatric-specific models are necessary for a more accurate prognosis estimation of elderly patients with TBI. Our findings suggest that frailty measured by CFS and assessment of comorbidities by CCI adds prognostic value, while muscularity at various locations (as assessed in CT imaging) had no effect on 30-day mortality after TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"378-386"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Symptom Resolution in Pediatric Patients Seen in a Multidisciplinary Concussion Clinic.","authors":"Kurt J Nilsson, Kristi Pardue, Yong Gao, Naida Dillion, Rachel S Johnson, Hilary Flint","doi":"10.1097/HTR.0000000000001049","DOIUrl":"10.1097/HTR.0000000000001049","url":null,"abstract":"<p><strong>Objective: </strong>Describe epidemiology of pediatric patients with concussion and relationship of injury characteristics and demographic variables to symptom resolution.</p><p><strong>Setting: </strong>Outpatient hospital system multidisciplinary concussion clinic.</p><p><strong>Participants: </strong>N = 1653, 6- to 18-year-old patients with concussion.</p><p><strong>Design: </strong>Retrospective of patients with concussion seen between 2013 and 2019. Rivermead post-concussion symptom questionnaire was completed at each visit. Demographics and injury characteristics were extracted, and income tertiles were calculated by zip code.</p><p><strong>Main measures: </strong>Descriptive statistics. Multivariate analysis of variance and Cox regression analysis of demographic variables and injury characteristics with time to symptom resolution.</p><p><strong>Results: </strong>Patients were 44.5% (n = 735) female, 53.5% (n = 885) male, and 2% (n = 33) other/not available. About 376 (22.7%) patients were 6 to 12 years old, 1277 (77.3%) were 13 to 18 years old. Median family income tertiles were <$63 798 (n = 494 [29.9%]), $63 798 to $82 171 (n = 571 [34.5%]), and >$82 171 (n = 545 [33%]). Time to presentation was longer for female patients ( P < .0005), patients with non-sports-related concussions ( P < .0005), and patients in the lower family income group than the middle- ( P = .02) and high-income groups ( P = .003). Average symptom resolution was 41 days, with higher initial symptom scores (hazard ratio 0.97; 95% confidence interval (CI), 0.97-0.98; P < .0005), female sex (hazard ratio 1.31; 95% CI, 0.1.18-1.47; P < .0005), older age (hazard ratio 1.17; 95% CI, 1.03-1.33; P = .015), and having a psychiatric diagnosis (hazard ratio 1.33; 95% CI, 1.15-1.54; P < .0005) predicting longer recovery time.</p><p><strong>Conclusion: </strong>Pediatric patients presenting to a specialized multidisciplinary concussion clinic possess several similar predictors of protracted symptom recovery when examined against other cohorts described in the literature, including female sex, longer time to initial presentation and initial concussion symptom burden. In this study, children with non-sports-related concussion have different clinical courses than those with sports-related concussion, and children 6 to 12 years old recover more quickly than adolescents. These findings, in combination with existing literature and future prospective studies, can be used to counsel patients regarding expected resolution of concussion symptoms and help direct resources toward those patients at risk for protracted recovery.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E369-E379"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}