Brain injuryPub Date : 2026-08-02DOI: 10.1080/02699052.2026.2710725
Jalil I Hussein, Younus Khudhur Baeez
{"title":"Association of protocol-driven care with complication rates in severe traumatic brain injury: a two-hospital quasi-experimental study in a resource-limited setting.","authors":"Jalil I Hussein, Younus Khudhur Baeez","doi":"10.1080/02699052.2026.2710725","DOIUrl":"https://doi.org/10.1080/02699052.2026.2710725","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of implementing Brain Trauma Foundation (BTF) guidelines on complication rates and clinical outcomes in severe traumatic brain injury (STBI) in a resource-limited setting.</p><p><strong>Methods: </strong>A quasi-experimental study (<i>n</i> = 70) was conducted in a resource-limited setting. Control group (<i>n</i> = 35) received routine care; study group (<i>n</i> = 35) was managed according to BTF guidelines. Complications (fever, pressure ulcers, hyperglycemia, infection, increased ICP) were collected daily. Outcomes included complication rates/severity, ventilation days, ICU stay, and Glasgow Outcome Scale Extended (GOSE).</p><p><strong>Results: </strong>The study group had significantly lower complication rates: fever (37.1% vs. 62.9%, <i>p</i> = 0.055), bed sores (5.7% vs. 31.4%, <i>p</i> = 0.0065), hyperglycemia (31.4% vs. 57.1%, <i>p</i> = 0.05), infection (20.0% vs. 51.4%, <i>p</i> = 0.01), and increased ICP (11.4% vs. 42.9%, <i>p</i> = 0.006). Mean complications per patient were lower (1.9 ± 1.2 vs. 2.8 ± 1.5, <i>p</i> = 0.006). Early surgery (48-72 h) was associated with lower complication rates. Complication occurrence strongly predicted unfavorable outcomes.</p><p><strong>Conclusions: </strong>Implementing BTF guidelines was associated with lower complication incidence and severity in STBI patients in a resource-limited setting. Protocol-driven care and early surgery were associated with fewer complications, which strongly predicted better functional outcomes.However, because the intervention and control groups were treated at different hospitals with differing resources, these findings should be interpreted as hypothesis-generating rather than causal.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"1-10"},"PeriodicalIF":1.5,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain injuryPub Date : 2026-08-01Epub Date: 2026-05-28DOI: 10.1080/02699052.2026.2680662
Nicholas T Tomasko, Thomas A Buckley, Alexandra C Kelleher, Katelin H Abdallah, Kelsey R Mello, Jessica L Miller, Katherine J Hunzinger
{"title":"The relationship between concussion and subsequent upper body musculoskeletal injury in NFL players.","authors":"Nicholas T Tomasko, Thomas A Buckley, Alexandra C Kelleher, Katelin H Abdallah, Kelsey R Mello, Jessica L Miller, Katherine J Hunzinger","doi":"10.1080/02699052.2026.2680662","DOIUrl":"10.1080/02699052.2026.2680662","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether National Football League (NFL) players who sustain a concussion are at increased risk of same-season upper body musculoskeletal injury (UBMSI) compared to matched controls.</p><p><strong>Methods: </strong>Injuries were identified using publicly available NFL.com injury reports from the 2015-2017 regular seasons. Concussions were verified, required return to ≥1 subsequent game, and only the first per season was analyzed; cases with concurrent concussion and UBMSI were excluded. Each concussed player was matched to a teammate of the same or closely related position without reported injury. Descriptive statistics were calculated, a chi-square test compared UBMSI frequencies, and a Cox proportional hazards model estimated the relative risk of post-concussion UBMSI.</p><p><strong>Results: </strong>A total of 322 concussed players and 322 matched controls were included (<i>N</i> = 644). UBMSI occurred in 14.3% of concussed players versus 8.1% of controls, χ<sup>2</sup> (1) = 6.25, <i>p</i> = 0.012. Across 4,585 participant-weeks, 72 post-return-to-play UBMSI events occurred. Concussed players had a significantly higher hazard of UBMSI (HR = 1.83, 95% CI: 1.13-2.96, <i>p</i> = 0.014).</p><p><strong>Conclusion: </strong>Concussed NFL players were 83% more likely to sustain a same-season post-return-to-play UBMSI. This is the first league-level evidence linking concussion to elevated UBMSI risk in professional football, highlighting the need to address post-concussive injury vulnerability in return-to-play protocols.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"857-863"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain injuryPub Date : 2026-08-01Epub Date: 2026-07-18DOI: 10.1080/02699052.2026.2705355
Michelle Andary, Hannah Bertagnolli, Antonis Costeas, Adam G Lamm
{"title":"Using intrathecal baclofen for effective management of paroxysmal sympathetic hyperactivity secondary to cerebral fat emboli syndrome: a case report.","authors":"Michelle Andary, Hannah Bertagnolli, Antonis Costeas, Adam G Lamm","doi":"10.1080/02699052.2026.2705355","DOIUrl":"10.1080/02699052.2026.2705355","url":null,"abstract":"<p><strong>Background: </strong>High energy impacts, such as motor vehicle accidents, may present with cooccurring long bone fractures and traumatic brain injuries. Cerebral fat emboli syndrome (FES) is one complication of long bone fractures which, in severe cases, may result in paroxysmal sympathetic hyperactivity (PSH).</p><p><strong>Case description: </strong>This case report presents a patient with treatment refractory PSH which persisted more than six months after initial injury when he first presented to an outpatient physiatry clinic. His clinical presentation at that time included spasticity, dystonia, diaphoresis, and tachycardia despite attempts at managing PSH with five different oral medications. An intrathecal baclofen trial was recommended which demonstrated significant improvement in PSH manifestations and an intrathecal pump was implanted as a result. Within three months following intrathecal baclofen pump placement, all oral medications for PSH were discontinued.</p><p><strong>Discussion/conclusion: </strong>To our knowledge, this is the first report of successful treatment of treatment refractory PSH secondary to cerebral fat emboli syndrome successfully treated with intrathecal baclofen. Early initiation of ITB in such instances can improve functional outcomes, decrease risk of polypharmacy, and reduce caregiver burden.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"1012-1014"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain injuryPub Date : 2026-08-01Epub Date: 2026-07-05DOI: 10.1080/02699052.2026.2697496
Alexis Demas
{"title":"The pugilist and the price of controlled violence.","authors":"Alexis Demas","doi":"10.1080/02699052.2026.2697496","DOIUrl":"10.1080/02699052.2026.2697496","url":null,"abstract":"<p><p>The Hellenistic bronze known as <i>The Boxer at Rest</i> presents one of the most striking representations of trauma in ancient art. Unlike the idealized athletic bodies of Classical Greece, the sculpture depicts a fighter marked by swelling, facial asymmetry, auricular deformity, scars, and signs of repeated injury. Viewed through a contemporary medical lens, these features correspond closely to the cumulative consequences of chronic exposure to blunt-force trauma. This article examines the sculpture at the intersection of medicine, neuroscience, and anthropology. The visible injuries represented by the artist evoke conditions that remain familiar to modern clinicians caring for athletes involved in combat sports. Beyond the external signs of trauma, the work also invites reflection on the invisible neurological consequences of repetitive head impacts, including chronic traumatic encephalopathy and other long-term sequelae of brain injury. The sculpture serves as a starting point for a broader discussion of regulated violence as a recurring feature of human societies. From ancient boxing and gladiatorial combat to contemporary boxing and mixed martial arts, organized forms of violence have persisted despite increasing awareness of their biological costs. The Boxer at Rest thus emerges not only as an artistic masterpiece but also as a clinical document and an ethical prompt, illustrating the enduring tension between admiration for human resilience and recognition of the physical and neurological damage incurred in its pursuit.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"1015-1017"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patient outcomes post self-inflicted traumatic brain injury during the acute phase.","authors":"Lauren Stamm, Lidia Panier, Angelica-Rhose Rivera, Maude Laguë-Beauvais, Judith Marcoux","doi":"10.1080/02699052.2026.2687090","DOIUrl":"10.1080/02699052.2026.2687090","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence of Self-inflicted Traumatic Brain Injury (Si-TBI) patients within a large clinical TBI sample, and to compare Si-TBI patients with matched controls on pre- and post-injury characteristics and functional outcomes.</p><p><strong>Method: </strong>In this retrospective matched case-control study, all TBI patients admitted between 2015 and 2021 were screened to identify cases of Si-TBI. Each Si-TBI patient was matched to two non-Si-TBI controls based on age, sex, education level, TBI severity, and mechanism of injury. Variables of interest included premorbid psychosocial and medical characteristics, and acute outcome measures such as Glasgow Outcome Scale - Extended (GOSE), length of stay (LOS), and discharge destination.</p><p><strong>Results: </strong>In total, 1.6% of all TBIs were Si-TBIs. Si-TBI patients were associated with a greater psychiatric history (<i>p</i> < 0.001), poorer social support (<i>p</i> < 0.001), higher Injury Severity Scores (ISS) (<i>p</i> = 0.002), longer LOS (<i>p</i> = 0.033), and lower GOSE (<i>p</i> = 0.003). During hospitalization, more Si-TBI patients exhibited verbal aggression (<i>p</i> = 0.002), required sitters (<i>p</i> < 0.001), and received psychiatric diagnoses (<i>p</i> < 0.001) and medications (<i>p</i> = 0.002). Exploratory bivariate correlations within the Si-TBI group showed expected associations between injury severity indicators and functional outcomes, with more severe injuries linked to poorer recovery markers.</p><p><strong>Conclusions: </strong>Si-TBI patients possess a more complex pre-morbid status, more severe injuries, more resource-intensive hospitalization, and poorer outcomes.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"910-918"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tablet-based cognitive self-assessment: English translation of Cog-First app.","authors":"Camille Heslot, Alexis Schnitzler, Franck Tarpin-Bernard, Valentine Facque, Jennifer Yao, Eshaa Nathoo, Emmanuel Mandonnet, Rajiv Reebye","doi":"10.1080/02699052.2026.2704930","DOIUrl":"10.1080/02699052.2026.2704930","url":null,"abstract":"<p><strong>Purpose: </strong>Acquired brain injuries (ABI) frequently lead to cognitive impairments, which can be challenging to detect and persist for years, negatively impacting patient outcomes. Timely and specific screening is crucial for proper management. Cog-First is a tablet-based self-assessment of executive functions, memory, and attention lasting approximately 20 min. This study aimed to develop the English version of Cog-First and evaluate its feasibility.</p><p><strong>Materials and methods: </strong>A two-phase study was conducted. Phase 1 involved a rigorous translation and cultural adaptation process, following established guidelines. Phase 2 consisted of an exploratory comparison between MoCA and Cog-First scores in individuals with ABI.</p><p><strong>Results: </strong>The English version of Cog-First was developed. Practitioners highly rated the relevance and applicability. Strong agreement (90%) was observed for memory, attention and inhibition sub-tests. About 90% of ABI participants expressed a high level of satisfaction. Exploratory analyses showed an association between MoCA and Cog-First scores (<i>p</i> = 0.037, <i>r</i> = .46).</p><p><strong>Conclusion: </strong>This study successfully translated and culturally adapted Cog-First into English and demonstrated its feasibility and acceptability in English-speaking individuals with ABI. While further research is required to explore its psychometric properties, normative values and clinical utility comprehensively, Cog-First might enhance the detection of subtle cognitive deficits and inform targeted rehabilitation strategies.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"985-993"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain injuryPub Date : 2026-08-01Epub Date: 2026-07-28DOI: 10.1080/02699052.2026.2677638
Mei Yu, Yanman Long, Honghui Xu
{"title":"Executive function's influence on problem behaviors in children with mild traumatic brain injury.","authors":"Mei Yu, Yanman Long, Honghui Xu","doi":"10.1080/02699052.2026.2677638","DOIUrl":"10.1080/02699052.2026.2677638","url":null,"abstract":"<p><strong>Background: </strong>Previous research has consistently demonstrated an increased prevalence of behavioral problems among children with mild traumatic brain injury (mTBI). However, the underlying mechanisms and contributing factors, particularly the role of executive function, remain insufficiently understood and require further investigation.</p><p><strong>Methods: </strong>We conducted moderation analyses using data on executive function and the Child Behavior Checklist (CBCL) from a sample of 10,805 children aged 9-11 years old participating in the Adolescent Brain Cognitive Development (ABCD) Study to examine the impact of executive function on problem behaviors. The executive function tasks included the 2-back task, flanker task, and dimensional change card sort (DCCS) task, which assessed working memory, inhibition, and cognitive flexibility, respectively.</p><p><strong>Results: </strong>Our findings revealed that for children with low levels of working memory (especially female children) and inhibition (especially male children), those with mTBI demonstrated significantly more behavioral problems compared to their counterparts. Importantly, this association was substantially attenuated in children with high levels of working memory and inhibition.</p><p><strong>Conclusion: </strong>Our results revealed that executive function (specifically working memory and inhibition) serves as a significant protective factor moderating the association between mTBI and problem behaviors in children.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"945-956"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain injuryPub Date : 2026-08-01Epub Date: 2026-07-01DOI: 10.1080/02699052.2026.2696033
Thomas A Buckley, Scott W Passalugo, Caitlin A Gallo, Barry Bodt, Kelsey M Evans, Barry A Munkasy
{"title":"Immediate vs delayed concussion reporting: role of concussion knowledge, attitudes, and symptoms.","authors":"Thomas A Buckley, Scott W Passalugo, Caitlin A Gallo, Barry Bodt, Kelsey M Evans, Barry A Munkasy","doi":"10.1080/02699052.2026.2696033","DOIUrl":"10.1080/02699052.2026.2696033","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to identify if concussion knowledge and attitude scores differed between collegiate student-athletes with immediate or delayed concussion reporting.</p><p><strong>Methods: </strong>There were 67 student-athletes who were divided into 'Immediate' (<i>N</i> = 35) and 'Delayed' (<i>N</i> = 32) reporting of non-obvious concussions. Participants completed the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) questionnaire, which is composed of a concussion knowledge index (CKI, 0-24) and attitude index (CAI, 15-75) with higher scores reflecting better performance. Groups were compared with a pooled two-sample t test, and a binary logistic regression was performed with three predictors (CKI, CAI, Symptoms).</p><p><strong>Results: </strong>There were no group differences for CKI Score (Immediate: 20.2 ± 2.9 vs Delayed: 19.8 ± 2.5; t(65) = 0.68, <i>p</i> = 0.501, d = 0.17), but the Delayed group had a significantly higher CAI score (Immediate: 51.9 ± 6.8 vs Delayed: 55.8 ± 9.1, t(65) = -2.00, <i>p</i> = 0.050, d = -0.49). Higher CKI (OR: 1.31, 95% CI [1.03, 1.75]) and Symptoms (OR: 1.05, 95% CI [1.00, 1.09]) increased the unit odds of Immediate report, but higher (safer) CAI had lower unit odds of Immediate report (OR: 0.89, 95% CI [0.79, 0.98]).</p><p><strong>Conclusion: </strong>Concussion reporting remains a complex process which likely includes intrinsic (i.e. knowledge and attitude) factors, non-modifiable factors (e.g. symptoms), and environmental factors which challenges sports medicine clinician's ability to increase athlete's self-report of potential concussions.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"927-934"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain injuryPub Date : 2026-08-01Epub Date: 2026-07-15DOI: 10.1080/02699052.2026.2696975
Maqsood Hussain Shah, Davood Roshan, Jennifer Pugh, James Murray, Colm Fuller, Stacey Kung, Alannah Reville, Siobhán O'Connor
{"title":"Improving concussion assessment in jockeys: normative benchmarks and web-based tool for ImPACT interpretation.","authors":"Maqsood Hussain Shah, Davood Roshan, Jennifer Pugh, James Murray, Colm Fuller, Stacey Kung, Alannah Reville, Siobhán O'Connor","doi":"10.1080/02699052.2026.2696975","DOIUrl":"10.1080/02699052.2026.2696975","url":null,"abstract":"<p><strong>Objective: </strong>Despite horse racing's exceptionally high concussion risk, there is no jockey-specific ImPACT study. This work aimed to develop demographically adjusted, jockey-specific ImPACT norms and to evaluate complementary approaches to clinical classification.</p><p><strong>Methods: </strong>Retrospective baseline data from 663 Irish jockeys (2021-2024) were analyzed. Two normative methods were applied: (i) a univariate regression-based approach estimating expected scores for each cognitive domain independently, adjusting for age, sex, and education, with percentile-based classification; and (ii) a multivariate regression-based tolerance region method jointly modeling cognitive outcomes to estimate a (95%/95%) tolerance region. Concordance and discordance between methods were examined, and demographic effects on derived cutoffs were quantified.</p><p><strong>Results: </strong>Both methods demonstrated complementary diagnostic value. Multivariate tolerance regions reduced overinterpretation of isolated low scores, whereas univariate regression was more responsive to domain-specific deviations. Performance profile in Irish jockeys was lower than that reported in other athletic populations, with protective effects of education, age-related decline, and superior performance observed among female jockeys.</p><p><strong>Conclusion: </strong>Combined use of univariate and multivariate normative approaches provides a more robust framework for interpreting ImPACT performance. An interactive web-based application was developed to support clinical and research use. Although applied here to horse racing, this framework is readily transferable to other sports.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"957-966"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}