Journal of neurotrauma最新文献

{"title":"Cystatin C as a Predictor of Severe Hospital-Acquired Pneumonia in Traumatic Brain Injury Patients: A Cohort Study.","authors":"Yanglingxi Wang, Weiduo Zhou, Dalin Wen, Yongbing Deng, Xiaodong Zhao, Hongwei Ruan, Anqiang Zhang, Peng Chen","doi":"10.1177/08977151251381354","DOIUrl":"https://doi.org/10.1177/08977151251381354","url":null,"abstract":"<p><p>This study aimed to identify core differential proteins associated with severe hospital-acquired pneumonia (sHAP) complicating the hospitalization of traumatic brain injury (TBI) patients through proteomic analysis. It further explored their association with sHAP and evaluated their predictive value. This single-center cohort study collected general clinical characteristics and biological indicators from 153 TBI patients admitted to the neurosurgery department of Chongqing Emergency Medical Center between February 4, 2021, and May 10, 2024. We performed quantitative analysis of differential proteins associated with sHAP and identified Cystatin C (CysC) as a key differential protein. Logistic regression modeling assessed the correlation between serum CysC concentration at the 24-h cut-off point and the occurrence of sHAP. The predictive value of CysC for sHAP was evaluated using the Receiver Operating Characteristic (ROC) curve and the Kaplan-Meier method. The study included 153 TBI patients with a mean age of 48.7 ± 14.6 years, comprising 118 (77.1%) males and 35 (22.9%) females. Of these, 43 patients developed sHAP, with a mean CysC serum concentration of 120.8 ± 17.7 µg/L, while the 110 patients who did not develop sHAP had a mean CysC serum concentration of 92.7 ± 18.4 µg/L. After adjusting for multiple factors, each 1 µg/L increase in CysC levels was associated with a 9% increase in sHAP incidence (OR: 1.09, 95% CI: 1.06-1.13). In the ROC curve analysis, CysC demonstrated a sensitivity of 79.1% and specificity of 80.9% at a threshold of 111.75 µg/L, showing superior predictive efficacy compared with traditional inflammatory markers. Kaplan-Meier curves indicated a higher incidence of sHAP in TBI patients with CysC ≥111.75 µg/L. This study innovatively explored CysC at the proteomic level, identifying it as a key protein associated with sHAP in TBI patients. Our findings suggest that serum CysC levels may not only indicate renal function but also reflect systemic inflammation and other pathological states. Elevated CysC levels at 24 h post-admission were significantly linked to an increased risk of sHAP, with this association persisting after adjusting for relevant factors. Notably, CysC demonstrated superior accuracy in predicting sHAP compared with traditional inflammatory markers such as WBC and Neu#. Thus, CysC holds potential as a novel indicator for assessing sHAP risk in TBI patients post-admission. Further studies are needed to validate its clinical utility and broaden its application.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial Pressure as a Dynamic Predictor of Traumatic Brain Injury Outcomes: A Scoping Review.","authors":"John H Kanter, Robert C Osorio, Abel Torres-Espin, Alexys Maliga Davis, Brandon Foreman, David O Okonkwo, Geoffrey T Manley, H E Hinson","doi":"10.1177/08977151251380581","DOIUrl":"https://doi.org/10.1177/08977151251380581","url":null,"abstract":"<p><p>Intracranial pressure (ICP) monitoring remains a cornerstone in the management of severe traumatic brain injury (TBI), yet its utility as a dynamic predictor of outcomes continues to evolve. We aimed to examine the role of serial ICP measurements as a potential predictor of outcomes after TBI, to combine ICP data with cerebrovascular reactivity metrics, and to highlight emerging trends in ICP modeling such as machine learning-based predictive models. We conducted a rigorous scoping review following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines to investigate the utility of ICP monitoring as a dynamic predictor of outcomes following TBI. A systematic search of major databases identified relevant studies published between January 1, 1998, and August 1, 2024. Two reviewers identified relevant articles, and conflicts were adjudicated by a third. Data from the included studies were abstracted and synthesized. Analysis of 29 studies (<i>N</i> = 5,743 patients) revealed significant associations between specific ICP patterns and clinical outcomes. Key findings included threshold-dependent mortality predictions, the value of early monitoring patterns (i.e., patterns observed within the first 72 h post-injury), and the enhancement of predictive accuracy through integration with cerebrovascular reactivity indices. Many studies now explore ICP as a multidimensional metric rather than a straightforward number, but overarching conclusions are limited by inter-study variability in analysis. The integration of advanced monitoring techniques, the use of features capturing the temporal complexity of ICP, and machine learning approaches show promise in enhancing the predictive value of ICP monitoring as a new form of precision medicine. These findings support strong associations between specific ICP dynamic patterns and mortality and functional outcomes. Standardization of protocols and validation in diverse populations remain important challenges to address in future studies.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"0"},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Stratified Treatment Variations in Acute Intracranial Surgery for Traumatic Brain Injury in Europe: A Prospective Observational Study Within CENTER-TBI.","authors":"Rick J G Vreeburg, Ranjit D Singh, Jeroen T J M van Dijck, Hugo F den Boogert, John K Yue, Alfonso Lagares, Bart Depreitere, Wouter A Moojen, Alexander Younsi, Inge A M van Erp, Godard C W de Ruiter, Andrew I R Maas, Wilco C Peul, Thomas A van Essen","doi":"10.1177/08977151251379454","DOIUrl":"https://doi.org/10.1177/08977151251379454","url":null,"abstract":"<p><p>High-quality evidence to guide the practice of acute cranial surgery across age groups in traumatic brain injury (TBI) remains sparse. Current surgical guidelines generally do not consider age in their recommendations. The aim of the study is to evaluate acute cranial surgery rates and center treatment differences across age in TBI. Data were extracted from the prospective observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. The CENTER-TBI study included patients with TBI between 2014 and 2017 from 65 level 1 trauma centers across Europe and Israel. Data from all 27,358 patients with TBI enrolled in the CENTER-TBI core study (<i>n</i> = 4509) and registry (<i>n</i> = 22,849) were considered. Eight patients with missing age were excluded, leading to a final analytic sample of 27,350 (core study <i>n</i> = 4504, registry <i>n</i> = 22,846). Variations in probability, defined as case-mix adjusted proportions, of acute surgical treatment of intracranial mass effect (primary decompressive craniectomy or craniotomy), performed within 24 h of initial injury, were expressed using median odds ratios (MORs). Adjusted odds ratios (aORs) were calculated using random-effects linear regression to assess the association between age and the probability of acute cranial surgery for acute subdural hematoma, epidural hematoma, or intracerebral hemorrhage/contusions. MORs and aORs were reported with 95% confidence interval (CI). The odds of acute surgery decreased with older age (aOR = 0.93, 95% CI: 0.92-0.95, per each interquartile range increase of 37 years [y]). Variations in center-specific surgery rates increased with age (15-24 y: MOR = 1.4; 25-44 y: MOR = 1.5; 45-64 y: MOR = 1.6; 65-79 y: MOR = 1.8; ≥80 y: MOR = 3.3), except for patients aged <15 y (MOR = 2.9). Older patients with TBI were less likely to receive acute cranial evacuation surgery, independent from other (comorbidity) factors. Higher age was associated with more surgical treatment variation between centers. Neurosurgery for TBI can be improved by age-personalized treatment algorithms.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postconcussive Sleep Problems and Glymphatic Dysfunction Predict Persistent Working Memory Decline.","authors":"Yi-Tien Li, David Yen-Ting Chen, Duen-Pang Kuo, Yung-Chieh Chen, Sho-Jen Cheng, Li-Chun Hsieh, Yung-Hsiao Chiang, Cheng-Yu Chen","doi":"10.1177/08977151251380701","DOIUrl":"https://doi.org/10.1177/08977151251380701","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Persistent working memory decline (PWMD) is a common sequela of mild traumatic brain injury (mTBI), yet reliable biomarkers for predicting long-term working memory outcomes remain lacking. The glymphatic system, a brain-wide waste clearance network, plays a crucial role in cognitive recovery. The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index, a noninvasive magnetic resonance imaging (MRI)-based technique, offers a promising approach to evaluate perivascular fluid dynamics-a key component of glymphatic function. However, its role in long-term working memory dysfunction remains underexplored, particularly in the presence of traumatic cerebral microbleeds (CMBs) and poor sleep quality-as measured by Pittsburgh Sleep Quality Index (PSQI)-both of which have been suggested to disrupt glymphatic clearance, exacerbate neurovascular impairment, and contribute to cognitive decline. This study aims to investigate the interplay between CMBs, sleep quality, and perivascular fluid dynamics in predicting PWMD after mTBI. We further assess the feasibility of a machine learning-based approach to enhance individualized working memory outcome prediction. Between September 2015 and October 2022, 3,068 patients presenting with concussion were screened, and 471 met the inclusion criteria for mTBI. A total of 184 patients provided informed consent, and 61 completed both baseline and 1-year follow-up assessments. In addition, 61 demographically matched healthy controls were recruited. Susceptibility-weighted imaging was used to detect CMBs, while perivascular fluid dynamics was assessed using the DTI-ALPS index. Sleep quality was evaluated using the PSQI, and working memory was measured with the Digit Span test at baseline and 1-year post-injury. Mediation analysis was conducted to examine the indirect effects of perivascular fluid dynamics on cognitive outcomes, and a machine learning model incorporating DTI-ALPS, CMBs, sleep quality, and baseline cognitive scores was developed for individualized prediction. CMBs were present in 29.5% of mTBI patients and were associated with significantly lower DTI-ALPS index values (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), suggesting compromised perivascular fluid dynamics and glymphatic impairment. Poor sleep quality (PSQI &gt; 8) correlated with lower 1-year Digit Span scores (&lt;i&gt;r&lt;/i&gt; = -0.551, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), supporting the link between disrupted glymphatic function and cognitive decline. Mediation analysis revealed that the DTI-ALPS index partially mediated the relationship between CMBs and PWMD (Sobel test, &lt;i&gt;p&lt;/i&gt; = 0.031). Machine learning-based predictive modeling achieved a high accuracy in forecasting 1-year working memory outcomes (&lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.78). These findings highlight the potential of noninvasive MRI-based assessment of perivascular fluid dynamics as an early biomarker for PWMD. Given the essential role of the glymphatic system in sleep and memory, integrating DTI-ALPS with CMB detecti","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locomotor Recovery in Spinal Cord Injury Can Be Assessed Using Weight-Bearing.","authors":"Courtney A Bannerman, Mitra Knezic, Julia P Segal, Amanda M Zacharias, Drew Harrigan, Sarah J Philips, Qingling Duan, Nader Ghasemlou","doi":"10.1177/08977151251380704","DOIUrl":"https://doi.org/10.1177/08977151251380704","url":null,"abstract":"<p><p>Spinal cord injury (SCI) can result in partial or full paralysis, depending on the level and completeness of injury. Locomotor function is often used as a measure of recovery and treatment outcomes. The Basso, Beattie, and Bresnahan scale and Basso Mouse Scale (BMS) are gold standards used in rodent SCI studies to evaluate changes in locomotor recovery. However, these scoring systems are observer-dependent measures that may be affected by the presence of an experimenter, particularly in studies where blinding is difficult. Observer-independent methods measure outcomes without an operator present, thus reducing bias and increasing reproducibility between research groups. Changes in locomotor recovery were evaluated after contusive SCI using the Advanced Dynamic Weight Bearing (ADWB) system, previously used successfully to assess acute and chronic pain. We observed a shift in body weight early after injury, with increased surface area and weight placement to the front paws and the trunk/tail region. Concurrently, there was a reduction in rear paw surface area and weight placement. As functional recovery occurred over time, there was a shift toward reduced weight placement on the front paws. As with locomotor recovery, these changes did not return to preinjury levels. We also found that the rate and degree to which mice shifted weight onto front paws depended on injury severity. Importantly, changes in weight distribution and surface area showed a strong correlation with BMS scores, suggesting that the observer-independent ADWB test is a viable measure to assess changes in locomotor function over time after SCI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Immunological Phenotypes in Individuals with Traumatic Spinal Cord Injury.","authors":"Debra Morrison, Camille Pinpin, Annette Lee, Cristina Sison, Ashley Chory, Peter K Gregersen, Gail Forrest, Steven Kirshblum, Susan J Harkema, Maxwell Boakye, James S Harrop, Thomas N Bryce, Jan M Schwab, Brian K Kwon, Adam B Stein, Matthew A Bank, Ona Bloom","doi":"10.1177/08977151251379477","DOIUrl":"https://doi.org/10.1177/08977151251379477","url":null,"abstract":"<p><p>Acutely after traumatic spinal cord injury (SCI), the immune system responds with an inflammatory cascade that promotes secondary damage to the spinal cord and systemic inflammation, which promotes persistent medical consequences. Here, we combined clinical and research data to evaluate cellular and molecular changes in the systemic immune system of individuals with SCI (SCI, N = 36) within 0-4 days after injury compared to uninjured individuals (CTL, N = 36). Analyzing blood samples by bulk-RNA Seq, 4752 differentially expressed (DE) gene transcripts were identified in SCI compared with CTLs, including increased expression of genes associated with inflammation and innate immunity (e.g., Neutrophil degranulation, Toll-Like Receptor signaling). Most participants with SCI had complete blood count data available, of whom 36% had elevated white blood cell and neutrophil counts, 24% had elevated monocytes, and 36% had lymphopenia. Significantly reduced expression of canonical natural killer (NK) cell, T cell and dendritic cell (DC) genes were identified, consistent with reduced frequencies of these cell types, determined by flow cytometry. Some molecular changes appeared to be influenced by motor completeness of injury. C-reactive protein, a validated clinical biomarker of inflammation, was significantly elevated after SCI, with levels higher in motor complete compared to motor incomplete injuries. This was also apparent for several other proinflammatory cytokines (e.g., High Mobility Group Box 1 protein, IL-6, IL-8). These data confirm and extend prior observations of cellular and molecular immunological changes, that may serve as potential biomarkers of injury severity, or as future therapeutic targets to improve health.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocognitive Network Organization in Children with Traumatic Brain Injury.","authors":"Cece C Kooper, Marsh Königs, Marjan E Steenweg, Maayke Hunfeld, Nienke Scheurer, Herman M Schippers, Willy Peper, Arne Popma, Job B M van Woensel, Dennis Buis, Marc Engelen, Hilgo Bruining, Jaap Oosterlaan","doi":"10.1177/08977151251376627","DOIUrl":"https://doi.org/10.1177/08977151251376627","url":null,"abstract":"<p><p>Pediatric traumatic brain injury (TBI) is the leading cause of acquired disability in children, potentially leading to neurocognitive deficits that affect daily functioning. This study explored the impact of pediatric TBI on neurocognitive network organization and its relation to intelligence and behavior problems. This observational multicenter study prospectively included 113 children with mild to severe TBI and 113 neurologically healthy (NH) children, matched for sex, age and socio-economic status. Six months post-TBI, neurocognitive functioning was assessed using computerized tests, intelligence outcome was assessed with Wechsler tests, and behavior problems were assessed through questionnaires. Conventional analysis of neurocognitive data involved calculating test performance scores, while network analysis involved the use of graph theory on individual neurocognitive data to explore neurocognitive network organization. Results of the conventional analysis showed that children with TBI had lower performance than NH children in Speed, Stability, Attention & Control, Verbal Working Memory, and Visual Working Memory (0.009 ≤ <i>p</i> ≤ 0.047, -0.42 ≤ <i>d</i> ≤ -0.29, small effect sizes). Network analysis showed lower <i>centralization</i> in the neurocognitive network organization of children with TBI compared to NH children (<i>p</i> = 0.04, <i>d</i> = -0.38). No differences were found in other network parameters (<i>p</i> ≥ 0.20). Neurocognitive network organization in children with TBI was related to intelligence (<i>R</i>² = 29.7%) and internalizing behavior problems (<i>R</i>² = 6.0%). Neurocognitive network organization was related stronger to externalizing behavior problems (<i>R</i>² = 21.6%, 95% CI = 13.7-34.6%) than measures of conventional neurocognitive performance (<i>R</i>² = 9.4%). This study indicates that pediatric TBI disrupts the neurocognitive network and is characterized by a less centralized organization compared to peers. Neurocognitive network organization may contribute to our understanding of outcomes following TBI, particularly regarding externalizing behavior problems.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Hyper- and Hypoventilation on Cerebral Physiology in a Healthy and Compromised Brain State: An Experimental Pig Model with State-of-the-Art Neuromonitoring.","authors":"Teodor Svedung Wettervik, Odin Joensen, Modar Alhamdan, Anders Hånell, Rozerin Kevci, Fartein Velle, Anders Lewén","doi":"10.1177/08977151251380274","DOIUrl":"https://doi.org/10.1177/08977151251380274","url":null,"abstract":"<p><p>Arterial carbon dioxide (pCO₂) strongly affects cerebrovascular tone and cerebral physiology. While moderate hyperventilation is often used to reduce intracranial pressure (ICP) in acute brain injury, its broader physiological effects remain unclear. In this experimental study, 10 anesthetized pigs underwent multimodal neuromonitoring, including ICP, cerebral perfusion pressure, common autoregulatory indices (pressure reactivity index [PRx], cerebral blood flow index [CBFx], oxygen reactivity index), CBF, brain tissue oxygenation (pbtO₂), and microdialysis. Animals were exposed to four ventilatory intervals (normoventilation, moderate and severe hyperventilation, and hypoventilation), first in a healthy state and then following induction of intracranial hypertension (ICP 30-40 mmHg) via epidural balloon inflation. In the <i>healthy brain</i>, moderate and severe hyperventilation numerically, but non-significantly, reduced CBF without affecting pbtO₂ or cerebral energy metabolism, while hypoventilation increased CBF and pbtO₂. Under intracranial hypertension, moderate hyperventilation improved PRx and preserved CBF, pbtO₂, and metabolism, but severe hyperventilation reduced pbtO₂. Hypoventilation produced variable responses: Animals with higher baseline blood pressure showed improved perfusion and oxygenation, whereas those with lower pressure experienced reduced CBF, impaired oxygenation, and metabolic distress. These findings underscore the complex and context-dependent effects of pCO₂ on cerebral physiology, indicating that ventilatory strategies may both benefit and harm the injured brain depending on individual vulnerability and hemodynamic status.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Action Collaborative on Traumatic Brain Injury Care: Adapted Clinical Practice Guideline.","authors":"Noah D Silverberg, Kathy Lee, Ana Mikolić, Mark T Bayley, David L Brody, E Wesley Ely, Joseph T Giacino, Cathra Halabi, Flora M Hammond, Daniel A Ignacio, Caterina Mosti, Joukje van der Naalt, Monique R Pappadis, Anita Ravi, Olli Tenovuo, Vincent Y Wang, Monica Verduzco-Gutierrez, Geoffrey T Manley","doi":"10.1177/08977151251378894","DOIUrl":"https://doi.org/10.1177/08977151251378894","url":null,"abstract":"<p><p>Outpatient follow-up care for traumatic brain injury (TBI) is inconsistent. The Action Collaborative on TBI Care, convened under the auspices of the National Academies of Sciences, Engineering, and Medicine, aimed to standardize management with a clinical practice guideline. The guideline is intended for community-dwelling adults with TBI who are able to care for themselves at hospital discharge or who did not require acute hospital care. Guideline topics were selected and prioritized with input from individuals with lived experience and clinicians. Existing evidence-based clinical practice guidelines (<i>k</i> = 18) were identified from systematic literature reviews. Recommendations for each priority topic were extracted from existing guidelines and synthesized using the ADAPTE process. Strength of evidence ratings were assigned based on the American Academy of Family Physician's adaptation of GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) through consensus voting. A draft guideline underwent external review by 20 health professional and brain injury organizations. The Action Collaborative on TBI Care guideline provides recommendations for 11 priority topics: (1) confirm the diagnosis; (2) determine whether emergency department evaluation is required; (3) request neuroimaging and neuropsychological assessment when indicated; (4) screen for social determinants of health; (5) provide guidance on return to usual activities; (6) educate the patient and family; (7) assess for risk of persistent symptoms; (8) prioritize which symptoms to target first; (9) initiate treatment for posttraumatic headache; (10) screen and initiate treatment for mental health disorders; and (11) decide if and when to refer to specialty care.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Two Models of Transition from Inpatient Rehabilitation Following Traumatic Brain Injury: A Pragmatic Comparative Effectiveness Trial.","authors":"Jeanne M Hoffman, Taylor Obata, Marcia A Ciol, Andrew Humbert, Jennifer Bogner, John D Corrigan, Kristen Dams-O'Connor, Simon Driver, Rosemary Dubiel, Flora M Hammond, Tessa Hart, Maria Kajankova, Megan Moore, Thomas K Watanabe, John Whyte, Jesse R Fann","doi":"10.1177/08977151251374298","DOIUrl":"https://doi.org/10.1177/08977151251374298","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Moderate to severe traumatic brain injury (msTBI) results in physical, cognitive, behavioral, and psychosocial difficulties. Those who receive inpatient rehabilitation following a msTBI need assistance after discharge. Patients and their families often struggle to find information, manage symptoms, and identify and access relevant services. Inadequate transition services from hospital-based care to the community can perpetuate and amplify the consequences of msTBI. There is a critical need for enhanced transitional care following hospital discharge. The goal of the current study was to compare two existing models for supporting the transition in the United States: 1. The Commission on Accreditation of Rehabilitation Facilities (CARF) model focused on transition planning prior to discharge (denominated Rehabilitation Discharge Plan [RDP]) and 2. The Veterans Health Administration model which provides a more intensive approach, extending beyond discharge, to enhance transitional care services (denominated Rehabilitation Transition Plan [RTP]). A six-center, 1:1 randomized pragmatic clinical trial with masked outcome assessment was conducted to compare the effectiveness of these two approaches. All participants received the RDP, including: 1. Patient and family education; 2. Written discharge instructions reviewed with the patient and family prior to discharge; and 3. A brief phone call from an inpatient care provider post discharge to identify any immediate problems. Those randomized to the RTP intervention also received up to 12 scheduled contacts during the 6 months following discharge from a trained care manager to assess needs, provide education, and resource facilitation. The primary outcomes were societal participation (participation assessment with recombined tools-objective) and quality of life (quality of life after brain injury scale) at 6 months post discharge. We hypothesized that patients randomized to RTP would report better participation and health-related quality of life (HRQoL) at the end of intervention and at 1-year post discharge compared with patients randomized to RDP. Second, we hypothesized that patients randomized to RTP would experience a steeper trajectory of improvement in participation and HRQoL over 12 months compared to patients randomized to RDP. A total of 925 patients were randomized. The results showed no significant differences between the two interventions on societal participation or HRQoL. Likewise, analysis of trajectory of outcomes did not show treatment group differences, and most patient participants had minimal change across all time points. Preinjury limitations, Medicaid insurance, and lower function contributed to worse outcomes but there was evidence for an interaction with the intervention for clinical sites and whether participants had an enrolled caregiver, which differed by group (increased participation with no enrolled caregiver in RTP, and better HRQoL with a caregiver for RDP). A key lim","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}