Journal of Head Trauma Rehabilitation最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/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":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-08","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":"Context Matters: Influence of Injury Context on Long-Term Psychiatric and Cognitive Outcomes in Combat Veterans With Mild Traumatic Brain Injury History.","authors":"Francesca V Lopez, Ruiyan Hu, Tanvi Krishnan, Kristine C Dell, William C Walker, Victoria C Merritt, Amy Jak","doi":"10.1097/HTR.0000000000001095","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001095","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between injury context with psychiatric and cognitive outcomes among combat-exposed Veterans and Service Members with remote mild traumatic brain injury (mTBI).</p><p><strong>Setting: </strong>Veterans and Service Members enrolled in the Long-Term Impact of Military-Relevant Injury Consortium (LIMBIC)-Chronic Effects of Neurotrauma Consortium (CENC).</p><p><strong>Participants: </strong>LIMBIC-CENC-enrolled participants who had sustained an mTBI exclusively in combat zones (c-mTBI +; n = 314), mTBI sustained exclusively in non-combat settings (c-mTBI-; n = 526), or no history of mTBI (no TBI; n = 347). Inclusion criteria for this study included (1) availability of all mTBI injury-related characteristics, (2) completion of all psychiatric symptom measures, and (3) completion of all neuropsychological measures used for this study.</p><p><strong>Design: </strong>Cross-sectional secondary analysis.</p><p><strong>Main measures: </strong>Primary outcomes of interest included total scores on self-reported psychiatric symptom measures (post-traumatic stress, neurobehavioral, and cognitive concerns) and objective cognitive composite test scores (attention, learning, processing speed, executive function, and delayed recall). All analyses adjusted for age, gender, and education.</p><p><strong>Results: </strong>Results of separate multivariate analyses of variance indicated that the c-mTBI+ group reported higher post-traumatic (ηP2 = .08) and neurobehavioral symptoms (ηP2 = .07), and cognitive concerns (ηP2 = .04) compared to the c-mTBI- and no TBI groups, whereas the c-mTBI- and no TBI groups did not differ except on cognitive concerns. Additionally, groups did not differ across cognitive composite performance except for significant though weak group differences on learning (ηP2 = .01), delayed recall (ηP2 = .03), and processing speed (ηP2 = .01). Separate hierarchical regression analyses indicated psychiatric symptom burden explained 7-18% of the total variance in cognitive composite performance as a function of mTBI group history (ps ≤ .002).</p><p><strong>Conclusions: </strong>These findings build upon prior work showing that injury context - the context in which mTBI occurs - may play an important role in long-term psychiatric and cognitive outcomes.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847101","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":"Newly Identified Suicidal Ideation and Suicide Attempts Among Military Service Members Following Traumatic Brain Injury, by Sex.","authors":"Lisa A Brenner, Melinda Tung, Jeri E Forster, Adam R Kinney, Alexandra A Smith, Rachel Sayko Adams, Jesus J Caban, Isabelle Wal","doi":"10.1097/HTR.0000000000001090","DOIUrl":"10.1097/HTR.0000000000001090","url":null,"abstract":"<p><strong>Objective: </strong>Although traumatic brain injury (TBI) has been identified as a risk factor for suicide among individuals from civilian and military cohorts, less is known about suicidal ideation (SI) and suicide attempts (SA), which often predate suicide. Moreover, little work has been conducted to evaluate sex-based differences.</p><p><strong>Data sources: </strong>Department of Defense, Military Health System (MHS), and Department of Veterans Affairs, Corporate Data Warehouse.</p><p><strong>Participants: </strong>Active Duty military service members (SM) with a history of TBI in the MHS (January 2000-March 2022); overall cohort with sex in medical record n = 354 972, males n = 305 284, and females n = 49 688.</p><p><strong>Design: </strong>Descriptive retrospective observational study.</p><p><strong>Main measures: </strong>In the MHS, index TBIs were identified via diagnostic codes. SI and SA codes were captured: (1) prior to index TBI; and (2) within 1, 2, and 5 years post-index TBI; total and newly identified. Sex was identified using MHS data.</p><p><strong>Results: </strong>Most injuries sustained by males and females were mild, 65.9% and 77.2%, respectively. Post-TBI incidence of SI and SA was higher than the prevalence of these diagnoses prior to TBI. At all post-TBI time points, the risk of SI and SA was significantly higher for females compared to males. The risk ratio (RR; females:males) at 1-year post-TBI was 1.59 (95% confidence interval [CI]: 1.48, 1.70) and 2.66 (95% CI: 2.06, 3.43), for SI and SA, respectively. Risk remained higher for females through 5-year post-TBI with SI RR = 1.20 (95% CI: 1.13, 1.26) and SA RR = 1.94 (95% CI: 1.58, 2.37).</p><p><strong>Conclusions: </strong>Findings highlight the risk of SI and SA by female and male SMs post-index TBI, with female SMs being at higher risk than males, as well as the need for suicide risk screening for those with a history of TBI. Implementing screening in settings where females commonly receive care should be considered.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956982","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":"Repetitive Head-Impact Exposure and Cognitive and Emotional Symptoms in Older Retired Female Collegiate Athletes.","authors":"Jeff Schaffert, Gavin D Sanders, Kristin Wilmoth, Logan Shurtz, Tara Driskill, Emma Wellington, Robbie Magill, C Munro Cullum","doi":"10.1097/HTR.0000000000001089","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001089","url":null,"abstract":"<p><strong>Objectives: </strong>This retrospective study examined whether contact sport participation, repetitive head impact (RHI) exposure, and concussion history were associated with cognitive and emotional symptoms in former collegiate female athletes.</p><p><strong>Setting: </strong>Archival data from the College Level Aging Athlete Study, a hybrid survey of over 1,000 former collegiate athletes aged 50 and older.</p><p><strong>Participants: </strong>Female athletes (n = 567) were categorized into contact (e.g., soccer, lacrosse, ice hockey, and rugby) and non-contact (e.g., golf, diving, swimming, and gymnastics) groups based on their primary collegiate sport.</p><p><strong>Design and main measures: </strong>Analyses of covariance, controlling for age and education, compared subjective cognitive decline (Cognitive Functioning Index), objective cognitive performance (Telephone Interview for Cognitive Status-40 Item Version), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder Scale-7), and emotional dysregulation (Neurological Quality of Life Emotional and Behavioral Dyscontrol). Additional ANCOVAs assessed interactions between contact sport status and RHI variables (self-reported concussions, age of first participation, and years played). A post hoc model examined whether emotional symptoms attenuated cognitive complaints using an emotional symptom index (aggregate of depression, anxiety, and emotional dysregulation measures). Models adjusted standard errors using a heteroskedasticity-consistent method, with significance corrected via the Holm-Bonferroni method.</p><p><strong>Results: </strong>Contact and non-contact athletes showed similar cognitive and emotional profiles. Concussion history was associated with greater subjective cognitive and emotional symptoms but not objective cognitive decline. Emotional symptoms predicted cognitive concerns better than concussion history.</p><p><strong>Conclusions: </strong>In this sample of aging female athletes, RHI exposure and concussions were not associated with objective cognitive impairment. Subjective concerns were greater in those with more reported concussions but were strongly influenced by emotional symptoms.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847104","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":"Sex Differences in Effects of Concussion History on Select Subscales From the Automated Neuropsychological Assessment Metrics (ANAM): Preliminary Findings of Performance in High School and Collegiate Athletes.","authors":"Susan Moore Mingils, Elli Vandeyacht, Kim Gorgens, Ann-Charlotte Granholm","doi":"10.1097/HTR.0000000000001092","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001092","url":null,"abstract":"<p><strong>Objectives: </strong>Sex differences have been identified in terms of post-concussion symptoms and recovery rate in athletes in high impact sports, although specific alterations in pre- and post-concussion cognitive measures have not been examined. Some studies show that either an acute concussion or a history of concussion can lead to cognitive impairment, with more pronounced long-term deficits observed in females. The objective in the current study was to examine differences in cognitive performance based on self-reported history of concussion and/or sex in NCAA Division 1 and high school athletes.</p><p><strong>Participants: </strong>Participants in high impact sports at an NCAA Division I university and high school were recruited.</p><p><strong>Method: </strong>Athletes completed 6 subscales from the Automated Neuropsychological Assessment Metrics (ANAM) UltraMobile as the primary outcome measure. Using a cross-sectional design, we investigated differences in cognitive performance based on sport-related concussion (SRC) history and potential interactions with biological sex using hierarchical regressions while accounting for age effects.</p><p><strong>Results: </strong>Findings revealed significant differences in concussion recovery, with female athletes reporting longer recovery time than males. Results of regressions indicated biological sex as a moderator of developmental trends in cognitive inhibition, with history of concussion potentially impairing inhibition (increasing impulsivity) in males but increasing inhibition (increasing hypervigilance) in females. Athletes with a history of SRC showed less improvement in simple reaction time (SRT) over a single ANAM administration compared to athletes with no history of SRC. Sex differences, regardless of concussion history, were identified for working memory and variability ofSRT, with females having faster and less variable reaction times.</p><p><strong>Conclusions: </strong>Potential implications include the use of the go-no/go, matching-to-sample, and SRT subscales on the ANAM UltraMobile along with calculating change in reaction time to detect prolonged deficits in cognitive performance following SRC which may vary by sex.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847105","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":"Exercise-Induced Symptom Exacerbation and Adverse Events in Moderate-to-Severe Traumatic Brain Injury.","authors":"Sara Gallow, Jennifer McGinley, John Olver, Dean McKenzie, Gavin Williams","doi":"10.1097/HTR.0000000000001093","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001093","url":null,"abstract":"<p><strong>Objective: </strong>To determine the incidence of exercise-induced symptom exacerbation and adverse events from cardiorespiratory fitness (CRF) and high-level mobility (HLM) exertional testing in the early subacute phase (≤3 months post-injury) following moderate-to-severe traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Inpatient TBI subacute rehabilitation unit.</p><p><strong>Participants: </strong>One hundred fifty adults and adolescents ≥15 years with moderate-to-severe TBI completed a total of 205 exertional tests (83 participants completed CRF only, 12 HLM only, and 55 both CRF and HLM).</p><p><strong>Design: </strong>Prospective observational cohort study. Consecutive admissions were screened for recruitment between August 2017 and August 2021. Symptom ratings were recorded pre- and post-CRF and HLM exertional testing on the Sports Concussion Assessment Tool symptom scale. A summed symptom severity score (SCAT-SS) was calculated with a ≥10-point increase classified as symptom exacerbation and a ≥10-point reduction classified as symptom improvement.</p><p><strong>Main measures: </strong>SCAT symptom scale.</p><p><strong>Results: </strong>One participant experienced a ≥10-point increase in SCAT-SS (ie, symptom exacerbation) post-CRF testing (1/138 = 0.7%, 95% confidence interval [CI] = 0.01%-4.0%) and 1 post-HLM testing (1/67 = 1.5%, 95% CI = 0.04%-8.0%). Sixteen of 138 (11.6%, 95% CI = 6.8%-18.1%) CRF tests resulted in a ≥10-point decrease in SCAT-SS (ie, symptom improvement). Nine of 67 (13.4%, 95% CI = 6.3%-24.0%) HLM tests resulted in a ≥10-point decrease in SCAT-SS. Participants were more likely to experience symptom improvement than symptom exacerbation for both CRF and HLM exertion (P ≤ .05). One adverse event, a fall, occurred during an HLM testing session.</p><p><strong>Conclusions: </strong>CRF and HLM exertional testing in the early subacute phase of recovery following moderate-to-severe TBI appears to be safe, with low rates of symptom exacerbation and adverse events identified.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847102","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":"Factors Associated With Cardiovascular Mortality After Complicated Mild to Severe Traumatic Brain Injury (TBI): A TBI Model Systems Study.","authors":"Shanti M Pinto, Bhaskar Thakur, Raj G Kumar, Umesh M Venkatesan, Amelia J Hicks, Simon Driver, Kan Ding, Thomas K Watanabe, Kathleen Bell, William C Walker, Sheryl Katta-Charles, Ross Zafonte, Amanda Rabinowitz, Flora M Hammond","doi":"10.1097/HTR.0000000000001087","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001087","url":null,"abstract":"<p><strong>Objective: </strong>To characterize factors associated with death due to cardiovascular causes following complicated mild to severe traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Chart review or telephonic interviews.</p><p><strong>Participants: </strong>Participants enrolled in the TBI Model Systems database.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Main measures: </strong>Primary cause of death due to cardiovascular causes coded with ICD-9 codes 390-459 or ICD-10 codes 100-199 (diseases of the circulatory system) on death certificates. A competing risk cause-specific Cox proportional hazards regression analysis was completed to identify demographic and injury-related factors associated with increased risk of cardiovascular-related mortality.</p><p><strong>Results: </strong>Overall, 15,370 participants were included. Overall, 2,770 (18.0%) individuals died, of which 595 (21.5%) died due to cardiovascular-related causes. Those who died due to cardiovascular causes were older (hazard ratio [HR] 1.08, 95% 1.07-1.09, P <.001), more likely to be male (HR 1.84, 95% CI 1.50-2.26, P <.001), divorced (HR 1.63, 95% CI 1.20-2.23, P = .002), and had lower functional independence measure motor scores (HR 0.99, 95% CI 0.98-0.99, P <.001). Individuals who identified as Asian/Pacific Islander (HR 0.21, 95% CI 0.08-0.55, P = .002), were employed (HR 0.65, 95% CI 0.46-0.90, P = .010), had private insurance (HR 0.77, 95% CI 0.60-0.99, P = .043), and had post-traumatic amnesia (PTA) duration >30 days (HR 0.71, 95% CI 0.55-0.92, P = .010) were less likely to die due to cardiovascular causes. Alcohol or drug use and education level were not significantly associated with death due to cardiovascular causes.</p><p><strong>Conclusion: </strong>Over 1 in 5 deaths following TBI were due to cardiovascular causes. Older age, male sex, being divorced, and having lower FIM motor scores are risk factors, whereas being employed, having private health insurance, and PTA >30 days are protective factors for cardiovascular mortality.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742260","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 in Those With Preexisting Disability: Prevalence, Characteristics, and Psychosocial Function.","authors":"Amelia J Hicks, Nicola L de Souza, Jill Del Pozzo, Noelle K Kurth, Jean P Hall, Kristen Dams-O'Connor","doi":"10.1097/HTR.0000000000001080","DOIUrl":"10.1097/HTR.0000000000001080","url":null,"abstract":"<p><strong>Objective: </strong>To identify the prevalence of incident traumatic brain injury with loss of consciousness (traumatic brain injury [TBI] with loss of consciousness [LOC]) among a cohort of individuals with preexisting disabilities. To examine age at first TBI with LOC and number of TBI with LOC. To identify whether TBI with LOC was associated with type of preexisting primary disability and age of disability onset. We also compared psychosocial function between those with and without TBI with LOC.</p><p><strong>Setting: </strong>2023/2024 National Survey on Health and Disability (NSHD).</p><p><strong>Participants: </strong>Adults aged ≥18 years, living in the US, with self-reported preexisting disabilities. Our analyses included 235 participants who reported TBI with LOC after the onset of their primary disability, and 1211 participants who did not experience TBI with LOC.</p><p><strong>Design: </strong>Cross-sectional observational online survey.</p><p><strong>Main measures: </strong>NSHD survey and abbreviated Brain Injury Screening Questionnaire.</p><p><strong>Results: </strong>A total of 235 individuals sustained TBI after disability onset. The average age of first TBI with LOC was 20.3 years, and 34.1% of participants incurred multiple TBIs with LOC. In fully adjusted models, relative to a primary physical/mobility disability, having a primary mental illness/psychiatric disability was associated with higher odds of incident TBI with LOC. Younger age at disability onset was associated with a 5% greater odds of reporting incident TBI with LOC. Finally, those with TBI with LOC were more likely to report poor physical and mental health days, and greater levels of loneliness, but did not have higher odds of unemployment compared to those without TBI.</p><p><strong>Conclusion: </strong>TBI with LOC in those living with preexisting disability is common, associated with younger age at disability onset, greater likelihood of poor physical and mental health days, and greater loneliness. Screening for TBI in those living with all-cause disability is warranted, alongside care coordination to meet care needs of this vulnerable but historically overlooked group.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707732","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":"Length of Stay as a Predictor of Long-Term Mortality in Patients Surviving a Traumatic Brain Injury: A Nationwide TBI Cohort Study of 153 177 Adults.","authors":"Christian Mirian, Therese Ovesen, Lasse Rehné Jensen, Thomas Scheike, Jacob Bertram Springborg","doi":"10.1097/HTR.0000000000001086","DOIUrl":"10.1097/HTR.0000000000001086","url":null,"abstract":"<p><strong>Objective: </strong>Our aim was to explore the length of stay (LOS) as a predictor of long-term mortality in patients surviving a traumatic brain injury (TBI). The objectives were to (1) establish TBI length of stay (LOS)-based groups empirically, (2) assess their accuracy in predicting death, and (3) compare the long-term risk of death between the LOS-based groups and non-TBI controls (Controls).</p><p><strong>Participants: </strong>Patients (≥18.0) with TBIs in Denmark between 1994 and 2018 that survived beyond discharge were (1:5) age-matched with Controls.</p><p><strong>Design: </strong>Nationwide cohort study. TBI patients and Controls were stratified according to age: 18.0-39.9, 40.0-69.9, and ≥70.0.</p><p><strong>Main measures: </strong>Adjusted binomial regression was used to estimate odd ratios for mortality, and predictive accuracy was assessed using cross-validated area under the receiver operation curve (AUC) values. The Kaplan-Meier method and the adjusted binomial regression models were used to compare the all-cause mortality between LOS-based groups and Controls.</p><p><strong>Results: </strong>Among 153 177 TBI survivors, LOS-based groupings showed modest stratification of mortality risk, particularly in those under 70.0 years. However, based on the AUC, they did not improve individual-level prediction of death once adjusted for key confounders. Compared with Controls, TBI survivors had persistently excess mortality risk of up to 20 years post-index across all age groups. In older adults, LOS was positively correlated with the number of new comorbidities detected during hospitalization, which likely contributed to the observation that TBI patients with short LOS had better survival than Controls in this age population (surveillance bias).</p><p><strong>Conclusions: </strong>LOS-based groups did not predict individual-level risk of death in TBI survivors but offered some short-term risk stratification at a group-level. Its application to group-level mortality outcomes in older adults is complicated by surveillance bias. Persistent excess mortality across all age groups supports the need for long-term follow-up after TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707731","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}