Journal of Head Trauma Rehabilitation最新文献

{"title":"Global Outcomes Across 20 Years After Inpatient Rehabilitation for Traumatic Brain Injury.","authors":"Gale G Whiteneck, John D Corrigan, Jessica M Ketchum, Angelle M Sander, Kurt Kroenke, Flora M Hammond","doi":"10.1097/HTR.0000000000001103","DOIUrl":"10.1097/HTR.0000000000001103","url":null,"abstract":"<p><strong>Objective: </strong>To explore and visually display differences in the distribution of the Glasgow Outcome Scale - Extended (GOS-E) over time after traumatic brain injury (TBI), focusing on variations in outcome distributions based on GOS-E at Year 1 postinjury and age at injury.</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>14 010 individuals who received inpatient rehabilitation in the TBI Model Systems.</p><p><strong>Design: </strong>Cross-sectional analysis of a prospectively collected longitudinal database.</p><p><strong>Main measures: </strong>GOS-E scores at 1, 2, 5, 10, 15, and 20 years postinjury, and age at injury.</p><p><strong>Results: </strong>The proportions of cases in each GOS-E category are displayed using 100% stacked bar graphs for each follow-up period. These graphs reveal that GOS-E at Year 1 and age at injury clearly influence outcomes over time. Trends include decreasing good recovery and increasing severe disability as Year 1 GOS-E worsens, along with rising mortality rates as age at injury increases.</p><p><strong>Conclusion: </strong>The study introduces a novel approach for visually representing patterns of change in GOS-E outcomes, emphasizing differences across strata defined by GOS-E at Year 1 and age at injury. The figures provide a valuable tool for communicating potential outcomes, particularly when GOS-E at Year 1 and age are known. Evaluating the visual interpretability of these graphs among persons with brain injury, family members, healthcare providers, and other stakeholders will help determine their broader usability and value.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E199-E206"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000714","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":"Examination of the Association Between History of Self-Reported Mild Traumatic Brain Injury and Neurocognitive Performance.","authors":"Wenjing Meng, Florin Vaida, Nicola L de Souza, Emily L Dennis, Elisabeth A Wilde, Joanna Jacobus, Xia Yang, Michael Cheng, Emily A Troyer, Everett L Delfel, Tracy Abildskov, John R Hesselink, Erin D Bigler, Jeffrey E Max","doi":"10.1097/HTR.0000000000001109","DOIUrl":"10.1097/HTR.0000000000001109","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether pediatric mild traumatic brain injury (mTBI) is associated with differences in neurocognitive functioning among children.</p><p><strong>Setting: </strong>Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study.</p><p><strong>Participants: </strong>Children with mTBI were compared to two control groups: children with orthopedic injury (OI) and children with no injury (NI). After excluding those with moderate/severe TBI, 450 children were classified as having mTBI, 1604 with OI, and 9814 with NI.</p><p><strong>Design: </strong>This is a cross-sectional analysis using the baseline data from a longitudinal observational study. Neurocognitive performance was assessed using task-based cognitive tests, including the National Institutes of Health Toolbox Cognition Battery (NIHTBX), Rey Auditory Verbal Learning Test, and the Little Man Task. Multiple imputation was used to address missing data. Linear regression models were used to compare cognitive performance across groups, adjusting for age, sex, race, ethnicity, parental income, parental education, and genetic ancestry.</p><p><strong>Main measures: </strong>The primary outcomes include the principal component scores representing General Ability, Executive Function , and Learning/Memory .</p><p><strong>Results: </strong>Unadjusted analyses showed children with mTBI had significantly higher scores than NI children on all three principal components. However, no significant differences remained after adjusting for confounders. No differences were found between mTBI and OI groups. Sensitivity analyses further adjusting for behavior and white matter microstructure resulted in same findings.</p><p><strong>Conclusion: </strong>After adjusting for demographic and genetic factors, no significant differences were found between children with mTBI and OI/NI. The findings highlight the importance of accounting for demographic, socioeconomic, and genetic confounders, as well as selecting appropriate control groups, when analyzing cognitive differences of children with mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E251-E261"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075475","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":"The Boston Assessment of Traumatic Brain Injury Lifetime, Second Edition (BATL-2): Development and Initial Psychometric Evaluation in Post-9/11 Military Veterans.","authors":"Tristan Colaizzi, Alexandra Kenna, Arielle Knight, Christine Clermont, Alyssa Currao, Catherine B Fortier","doi":"10.1097/HTR.0000000000001112","DOIUrl":"10.1097/HTR.0000000000001112","url":null,"abstract":"<p><strong>Objective: </strong>Describe the development and initial psychometric evaluation of the Boston Assessment of Traumatic Brain Injury (TBI) Lifetime, Second Edition (BATL-2).</p><p><strong>Setting: </strong>The Translational Research Center for TBI and Stress Disorders (TRACTS) located at two large VA medical centers.</p><p><strong>Participants: </strong>Random selection of 100 US post-9/11 military Veterans enrolled at TRACTS Boston primary site and 20 Veterans enrolled at TRACTS Houston secondary site.</p><p><strong>Design: </strong>Secondary analysis of a prospective longitudinal cohort study.</p><p><strong>Main measures: </strong>Boston Assessment of TBI-Lifetime (BAT-L), BATL-2, Ohio State University Traumatic Brain Injury Identification Method (OSU-TBI-ID).</p><p><strong>Results: </strong>BATL-2 instrument development included National Institute of Neurological Disorders and Stroke (NINDS) and American Congress of Rehabilitation Medicine (ACRM) field updates to TBI diagnostics, iterative review and feedback from stakeholders, and data-driven revisions. The BATL-2 demonstrated excellent diagnostic agreement with TBI diagnosis from the OSU-TBI-ID (κ = 0.94; sensitivity 100%; specificity 87.0%-92.5%). Internal consistency and diagnostic agreement between BATL-2 and the first edition BAT-L were high (Cronbach's α = 0.83; κ = 0.94). BATL-2 demonstrated convergent validity with neurobehavioral symptoms ( r = .260, p = .012) and discriminant validity with measures of depression ( r = .004, p = .966) and tobacco use ( r = .086 to .307, p > .553). Replication in a secondary sample showed robust diagnostic agreement (κ = 0.97).</p><p><strong>Conclusions: </strong>Results indicate that the BATL-2 is a valid and reliable measure of retrospective TBI diagnosis. Importantly, BATL-2 provides continuity of evidence-based assessment of TBI, including forward compatibility with updated field TBI diagnostic criteria while maintaining backward compatibility with BAT-L and previous TBI guidelines. The BATL-2 improves retrospective brain injury characterization by reducing administration time burden, assessing repetitive head impacts (RHI) and military occupational blast exposures (MOBE), and incorporating updated field standards.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"235-245"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238865","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":"Trauma Exposure Across the Lifespan Is Associated With Persistent Mild TBI Symptoms in US Military Veterans.","authors":"Seth G Disner, Colette E Mahr","doi":"10.1097/HTR.0000000000001134","DOIUrl":"10.1097/HTR.0000000000001134","url":null,"abstract":"<p><strong>Objective: </strong>Mild traumatic brain injury (mTBI) is common in military veterans, with most symptoms fully resolving within weeks but some persisting for months or years after injury. Chronic symptoms are often attributed to aftereffects of the physiological injury, but veterans are also exposed to higher rates of psychological trauma which take place before, during, and after their military service careers. The present study sought to investigate the relationship between psychological trauma across the lifespan and persistence of mTBI symptoms and postinjury quality of life in US military veterans.</p><p><strong>Setting and participants: </strong>A total of 463 veterans with a history of mTBI (88.1% male, age 18-92 years [mean age 45.7 years]) were recruited from a VA outpatient TBI clinic.</p><p><strong>Design and main measures: </strong>In this observational study, participants completed the Neurobehavioral Symptom Inventory (NSI) and Quality of Life after Brain Injury Questionnaire (QOLIBRI) as primary outcome measures. The history of mTBI was extracted from existing VA records, and veterans provided accounts of their cumulative lifetime trauma exposure, including trauma measures from their childhood, deployment, and postdeployment periods.</p><p><strong>Results: </strong>After controlling for demographic and mTBI characteristics, each trauma measure was significantly positively associated with NSI symptom severity (all partial η 2  > .033, all P < .004) and significantly negatively associated with QOLIBRI life satisfaction (all partial η 2  > .035, all P < .002). There were no significant associations between outcomes and mTBI characteristics after correcting for multiple comparisons. The associations between psychological trauma and mTBI outcomes were observed across most NSI and QOLIBRI symptom domains, including those more often attributed to physiological explanations (eg, NSI somatic, NSI vestibular, and QOLIBRI physical problem scales).</p><p><strong>Conclusion: </strong>These findings support the inclusion of comprehensive lifetime trauma assessment in chronic mTBI rehabilitation conceptualizations and underscore the potentially prominent role that psychological stressors play in the persistence of mTBI sequelae.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E189-E198"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557051","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":"Traumatic Brain Injury and Accelerated Epigenetic Aging Among Post-9/11 Veterans.","authors":"Kyle J Bourassa, Sarah L Martindale, Melanie E Garrett, Allison E Ashley-Koch, Jean C Beckham, Nathan A Kimbrel, Jared A Rowland","doi":"10.1097/HTR.0000000000001096","DOIUrl":"10.1097/HTR.0000000000001096","url":null,"abstract":"<p><strong>Objective: </strong>Military service over the last several decades has been associated with an increased risk of injuries, including traumatic brain injury (TBI). Veterans with a history of TBI often experience poor health outcomes and have higher rates of premature mortality. In this study, we examined whether accelerated biological aging could help explain negative health outcomes following TBI.</p><p><strong>Setting, participants, and design: </strong>We evaluated the association between TBI and rate of epigenetic aging (assessed using DunedinPACE) using data from post-9/11 veterans ( N = 1152) enrolled in the VA Mid-Atlantic (VISN 6) MIRECC Post-Deployment Mental Health cohort study.</p><p><strong>Main measures: </strong>TBI was assessed using self-report during a clinical interview categorized into three TBI groups (none, 1, 2 +), epigenetic aging was assessed using DunedinPACE derived from DNA methylation data.</p><p><strong>Results: </strong>Veterans who reported more lifetime TBI (β = 0.07, 95% CI [0.01, 0.14], P  = .029) or deployment-related TBI (β = 0.09, 95% CI [0.01, 0.18], P  = .046) had faster epigenetic aging. TBI during and after military service was more strongly associated with accelerated aging than TBI prior to military service, and deployment-related TBI was more strongly associated with accelerated aging for women veterans. Overall, associations were small to moderate in size.</p><p><strong>Conclusion: </strong>These findings show TBI could increase risk for accelerated aging and underscores its potential utility in identifying veterans who may face aging-related health issues. Early identification of TBI-related accelerated aging could inform interventions that mitigate long-term health risks as post-9/11 veterans transition into middle and older age.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"161-167"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873465","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":"STEP-Home Improves Neurobehavioral Symptoms and Reintegration in Veterans With TBI and Differentially Impacts Anger Control.","authors":"Caroline A Sablone, Michelle M Pebole, Emily J Van Etten, Adam Lebas, Alexandra C Kenna, Dylan Katz, Colleen B Hursh, Alyssa Currao, Jennifer R Fonda, Catherine B Fortier","doi":"10.1097/HTR.0000000000001094","DOIUrl":"10.1097/HTR.0000000000001094","url":null,"abstract":"<p><strong>Objective: </strong>To explore if the STEP-Home (SH) group workshop improves neurobehavioral symptoms, civilian readjustment, anger control, and frontal system function in post-9/11 Veterans with and without a TBI. This is a secondary analysis from a 2-arm randomized controlled trial (RCT).</p><p><strong>Participants: </strong>One hundred and ninety-five male and female post-9/11 Veterans participated in a multisite RCT of SH versus Present Centered Group Therapy; a subset of 66 who received the SH intervention and completed all assessments were selected for this analysis. Participants were grouped based on TBI diagnosis. Almost half had a history of TBI (TBI+ n = 28; 42.4%; mean age 38.6 ± 9.1 years) whereas 38 had no history of TBI (TBI- mean age 41.0 ± 12.2 years).</p><p><strong>Setting: </strong>VA Healthcare System and telehealth.</p><p><strong>Intervention: </strong>SH was a 12-week, 90 minute/week, transdiagnostic, skills-based group intervention focused on problem solving, emotion regulation, and anger control skill building.</p><p><strong>Main measures: </strong>Outcomes were neurobehavioral symptoms, anger control, reintegration status, and frontal system function. Data were collected at pre-treatment (T1), post-treatment (T2), and at 12-week post-treatment follow-up (T3).</p><p><strong>Results: </strong>Both groups (TBI+ and TBI-) showed significant improvements in neurobehavioral symptoms, reintegration status, and aspects of frontal system function. Anger control was only improved in the TBI+ group. Treatment benefits were maintained over time.</p><p><strong>Conclusions: </strong>The STEP-Home intervention shows promise for improving persistent neurobehavioral symptoms in Veterans with and without a history of TBI. Treatment benefits were maintained over time in both groups. Veterans with a history of TBI showed significant improvement in anger control, which is critical to improving daily functional status after brain injury. SH offers an acceptable, transdiagnostic alternative treatment approach to improve functioning for Veterans with TBI and those at risk for TBI/brain injury due to military service.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"189-199"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847106","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":"Psychological Health of Female Service Members and Veterans Associated With Mild Traumatic Brain Injury History: A LIMBIC-CENC Study.","authors":"Landon B Lempke, Samuel R Walton, Carrie Esopenko, Nicola L de Souza, Elisabeth A Wilde, Abigail C Bretzin, Ana Mills, David X Cifu, William C Walker, Jessie R Oldham","doi":"10.1097/HTR.0000000000001135","DOIUrl":"10.1097/HTR.0000000000001135","url":null,"abstract":"<p><strong>Objectives: </strong>To (1) evaluate differences in psychological health outcomes between US female service members and veterans (FSMVs) with and without mild traumatic brain injury (mTBI) history, and (2) examine the associations between psychological health and lifetime mTBI history, time since last mTBI, blast-mTBI history, and combat-mTBI history.</p><p><strong>Setting: </strong>Ten military and veteran health care study sites nationwide.</p><p><strong>Participants: </strong>FSMV enrolled in the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) study. We used 2:1 propensity score matching to match FSMVs with a prior mTBI (n = 148; age: 40.0 ± 8.7 years; time since last mTBI: 11.6 ± 9.4 years) to those without mTBI history (n = 74) on demographic and health-history confounders.</p><p><strong>Design: </strong>Prospective, longitudinal study design with current cross-sectional analysis.</p><p><strong>Main measures: </strong>FSMVs completed thorough health history evaluations and standardized assessments consisting of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL5), Patient Health Questionnaire-9 (PHQ-9), Neurobehavioral Symptom Inventory (NSI), Satisfaction With Life Scale (SWLS), and the Traumatic Brain Injury-Quality of Life (TBI-QoL) anxiety and emotional-behavioral dyscontrol modules.</p><p><strong>Results: </strong>Compared to the no mTBI group, FSMVs with any lifetime mTBI displayed worse PCL-5, PHQ-9, NSI, and TBI-QoL Anxiety total scores ( P ≤ .002), but not SWLS or TBI-QoL emotional-behavioral dyscontrol. Combat mTBI history demonstrated worse PCL-5, SWLS, and TBI-QoL Anxiety total scores ( P ≤ .047). Greater SWLS scores were observed for each year since their last mTBI ( P = .048). No significant differences for cumulative mTBI history or any blast-mTBI history were observed across outcomes ( P ≥ .146).</p><p><strong>Conclusions: </strong>FSMVs with ≥1 mTBI history reported greater psychological symptoms than those without. Among FSMVs with lifetime mTBI history, combat-mTBI history was associated with worse PTSD, life satisfaction, and anxiety symptoms. Our findings indicate that a single mTBI, notably combat-related, may adversely impact psychological health, but future research is necessary for longitudinal, comprehensive FSMV health understanding across the lifespan post-mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E178-E188"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557058","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":"Impact of Probable Deployment Traumatic Brain Injury on Post-9/11 Veteran's Productive Activity Participation After Service: A TVMI Study.","authors":"Kelsee M Stromberg, Erin D Bouldin, Dawne Vogt, Shannon R Miles, Angela P Presson, Megan E Vanneman, Thomas N Maloney, Mary Jo Pugh","doi":"10.1097/HTR.0000000000001088","DOIUrl":"10.1097/HTR.0000000000001088","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of probable deployment traumatic brain injury (TBI) history on post-9/11 US veterans' participation in productive activities-including employment, caregiving, volunteering, and education-after military service.</p><p><strong>Methods: </strong>This secondary cross-sectional analysis of the Veterans Metrics Initiative (TVMI) study examined productive activities among 8946 veterans who transitioned from service in 2016 and completed the TVMI survey. Associations between probable deployment TBI and activity engagement were analyzed using bivariate analysis and multinomial logistic regression. Probable deployment TBI, the independent variable, was defined as a head injury with loss or alteration of consciousness. The dependent variable was engagement in productive activities, categorized as neither paid nor unpaid labor (reference), paid labor only, paid and unpaid labor, and unpaid labor only. Covariates included demographic characteristics, self-reported premilitary TBI, and a positive screen for probable post-traumatic stress disorder (PTSD) identified using the PC-PTSD-5 screening tool.</p><p><strong>Results: </strong>Veterans with probable deployment TBI were significantly less likely to engage in paid labor only (risk ratio [RR] = 0.66, 95% confidence interval [CI]: 0.55-0.79, P < .001) or paid and unpaid labor (RR = 0.79, 95% CI: 0.65-0.96, P = .023) compared to those without TBI. Conversely, they were more likely to engage in unpaid labor only (RR = 1.23, 95% CI: 1.02-1.48, P = .024). These associations remained after adjusting for covariates described above.</p><p><strong>Conclusions: </strong>Productive activity engagement differed between veterans with and without probable deployment TBI. Veterans with probable deployment TBI were less likely to participate in paid labor and more likely to engage in unpaid or no labor. Additional support may be needed to facilitate their transition into the civilian workforce.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"181-188"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847103","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":"Frailty Evaluation for Short-Term Mortality Prediction of Patients With Traumatic Brain Injury: A Meta-Analysis.","authors":"Bin Lou, Jinyan Yu","doi":"10.1097/HTR.0000000000001100","DOIUrl":"10.1097/HTR.0000000000001100","url":null,"abstract":"<p><strong>Objective: </strong>Frailty is increasingly recognized as an important prognostic factor in trauma patients. Its role in predicting short-term mortality after traumatic brain injury (TBI), however, remains uncertain. A systematic review and meta-analysis were conducted to evaluate the association between baseline frailty and short-term mortality (within 12 months) in TBI patients.</p><p><strong>Methods: </strong>Cohort studies were identified through PubMed, Embase, and Web of Science up to March 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.</p><p><strong>Results: </strong>Fifteen datasets from 14 cohort studies, comprising 1 567 950 patients, were included. Frailty was significantly associated with increased short-term mortality (OR, 1.58; 95% CI, 1.30-1.93; P < .001; I2  = 93%). Sensitivity analyses showed consistent findings (OR range: 1.48-1.66). Subgroup analyses revealed stronger associations in prospective versus retrospective studies (OR, 3.27 vs 1.41; P < .001), and in studies involving general TBI populations compared to those focusing on subdural hematoma or intracranial hemorrhage (OR, 2.03 vs 1.19; P < .001). The association remained consistent across age groups and sex distribution. Although numerically stronger in studies using non-modified frailty index (OR 2.00 vs 1.31), the difference was not statistically significant ( P = .05). The association was most pronounced at 6-month follow-up compared to 1 month or during hospitalization and was attenuated in studies using multivariate rather than univariate analyses ( P < .001).</p><p><strong>Conclusions: </strong>Frailty may be independently associated with short-term mortality in patients with TBI. Incorporating frailty assessment may enhance risk stratification and support clinical decision-making.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E228-E242"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956911","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":"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":"221-234"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","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}