Understanding How Mild Traumatic Brain Injury Impacts the Career and Independence of Young Adults.

Research on mild traumatic brain injury (mTBI) and its impact on young adults is limited, despite this being an important time in their lives to work toward independence and career development. We analyzed data on 663 persons aged 17-29 years old with mTBI (i.e.

Vascular Risk Factors and 1-Year Cognitive Change Among Individuals With Traumatic Brain Injury.

Importance: Traumatic brain injury (TBI) and vascular risk factors are associated with cognitive impairment, but it is unknown if individuals with vascular risk factors experience worse cognitive outcomes after TBI.

Objective: To evaluate cognitive function among patients with TBI with vs without comorbid preinjury vascular risk factors.

Design, Setting, And Participants: This prospective cohort study examined individuals with TBI enrolled in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Study between February 26, 2014, and August 8, 2018, with a 1-year follow-up.

Patient Experiences of and Priorities for Traumatic Brain Injury Health Care in a US Level 1 Trauma Center: A Qualitative Study.

Objective: To learn patient perspectives about health care in a level I trauma center for traumatic brain injury (TBI) that inform the design of better TBI systems of care.

Patients And Methods: This was a community-engaged qualitative study that enrolled 42 individuals who had been either treated and discharged home from a level I trauma center emergency department (n=21, 50%) or who were admitted to the trauma center inpatient units (n=21, 50%). Interviews, conducted from August 12, 2022, to September 22, 2023, inquired about injury, post-acute and after post-acute care, clinical and community supports received, unexpected experiences, and things that helped or hurt access to care and outcome.

Distinct symptom recoveries based upon highest level of care in patients with sport-related concussion or traumatic brain injury and Glasgow Coma Scale 13-15.

There are limited data directly comparing recovery across traumatic brain injury subpopulations. We compared symptom recovery profiles between patients with Glasgow Coma Scale (GCS) 13-15 traumatic brain injury (TBI) from the same region in three cohorts: (1) Participants with sport-related concussion (SRC), (2) participants evaluated and discharged from the level 1 trauma center emergency department (ED), and (3) participants who required 1 + night(s) in the inpatient unit (IP). The current analysis aggregates data from two prospective cohort studies at the same institution resulting in a combined dataset of 395 patients with TBI (224 with SRC, 95 discharged from the ED, and 75 admitted [IP]).

Toward More Holistic Early Traumatic Brain Injury Evaluation and Care: Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Psychosocial and Environmental Modifiers Working Group.

Biopsychosocial and environmental factors play a major role in acute clinical presentation, recovery, and outcome of traumatic brain injury (TBI). As part of the 2024 National Institute of Neurological Disorders and Stroke (NINDS) TBI Classification and Nomenclature Initiative, the Psychosocial and Environmental Modifiers (PEM) Working Group was assembled to perform a narrative review and summary of expert opinions regarding how non-TBI factors influence the presenting features and outcomes of TBI and to make recommendations for incorporating these Modifiers into clinical care and research. With input from working group members and other interested parties, we summarize the membership, methods, and outcomes of the PEM Working Group activities.

A new characterisation of acute traumatic brain injury: the NIH-NINDS TBI Classification and Nomenclature Initiative.

The clinical severity of traumatic brain injury (TBI) is commonly classified according to the Glasgow Coma Scale (GCS) sum score as mild (13-15), moderate (9-12), or severe (3-8). A new approach is needed for characterising TBI more accurately. In 2022, the US National Institutes of Health-National Institute of Neurological Disorders and Stroke launched an international initiative to address this need, with a focus on the acute phase of injury.

Impact of Early Activity and Behavioral Management on Acute Concussion Recovery: A Randomized Controlled Trial.

Objective: To determine the efficacy of early physical activity and behavioral management for acute concussion in pediatric patients.

Study Design: A multicenter, prospective, 2 × 2 factorial randomized controlled trial was conducted among patients aged 11-24 years who presented within 72 hours of injury. Participants were randomized into 4 groups based on early physical activity (or usual care [UC]) and behavioral management (or none).

Follow up rates and patient interest in clinical care after mild traumatic brain injury presenting to a level 1 trauma center: a TRACK-TBI prospective cohort study.

Study Objective: To evaluate the rates of clinical follow-up and patient interest in clinical follow-up within the first year of traumatic brain injury (TBI) with presenting Glasgow Coma Scale (GCS) score between 13 and 15.

Methods: This is a secondary analysis of a prospective cohort study which enrolled patients with TBI first evaluated at a 1 of 23 level 1 trauma centers ( = 1,916). At 2 weeks and 3 months, the participants were asked "have you seen any healthcare provider for your TBI?" and "if so, did it help?.

Traumatic Brain Injury Diagnostic Interview: Development, Interrater Reliability, and 2-Week Post-Injury Clinical Profiles.

Because most traumatic brain injuries (TBIs) do not present with objective indicators (e.g., neuroimaging findings) to confirm the diagnosis, clinicians often rely on self- or observer-reporting of alteration of consciousness (AOC; e.

Contribution of Extracranial Injuries to GOSE Scores after Traumatic Brain Injury TBI: A TRACK-Traumatic Brain Injury Study.

The Glasgow Outcome Scale Extended (GOSE) is the most widely used outcome measure for hospital-based studies of traumatic brain injury (TBI). The GOSE may be administered several ways, the choice depending on the purpose of the research. In this investigation, we evaluated the effect of administering the GOSE to collect functional disability attributed to all injuries sustained (GOSE-All) or excluding the impact of extracranial injuries (GOSE-TBI).

Effect of blood alcohol on the diagnostic accuracy of glial fibrillary acidic protein and ubiquitin carboxy-terminal hydrolase L1 for traumatic intracranial hemorrhage: A TRACK-TBI study.

Background: Acute intoxication is common in patients evaluated for traumatic brain injury (TBI). However, the effect of elevated blood alcohol levels (BALs) on the diagnostic accuracy of FDA-cleared biomarkers for evaluating traumatic intracranial injury on computed tomography (CT) scan, namely, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), has not been well studied.

Methods: We investigated the effect of significantly elevated (>300 mg/dL) and modestly elevated BAL (81-300 mg/dL) at emergency department presentation on the diagnostic accuracy of GFAP and UCH-L1 for predicting a positive CT in patients presenting to 18 U.

Outcomes after Traumatic Brain Injury with and Without Computed Tomography.

Our recent improved understanding of traumatic brain injury (TBI) comes largely from cohort studies of TBI patients with indication for computed tomography (CT). Using CT head as an inclusion criterion may overestimate poor outcomes after TBI with Glasgow Coma Scale (GCS) 13-15. We aimed to compare outcomes after TBI in adults who had a head CT scan (with negative findings) versus those who had no CT when presenting to an emergency department.

Distinct trajectories of neuropsychiatric symptoms in the 12 months following traumatic brain injury (TBI): a TRACK-TBI study.

Background: Neuropsychiatric symptoms are common after traumatic brain injury (TBI) and often resolve within 3 months post-injury. However, the degree to which individual patients follow this course is unknown. We characterized trajectories of neuropsychiatric symptoms over 12 months post-TBI.

Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study.

Objectives: An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort.

Latent Profiles of Acute Symptoms, Cognitive Performance, and Balance in Sport-Related Concussions.

Background: A sport-related concussion (SRC) is a common injury that affects multiple clinical domains such as cognition, balance, and nonspecific neurobehavioral symptoms. Although multidimensional clinical assessments of concussion are widely accepted, there remain limited empirical data on the nature and clinical utility of distinct clinical profiles identified by multimodal assessments.

Purpose: Our objectives were to (1) identify distinct clinical profiles discernible from acute postinjury scores on the Sport Concussion Assessment Tool (SCAT), composed of a symptom checklist, a cognitive assessment (Standardized Assessment of Concussion), and a balance assessment (Balance Error Scoring System), and (2) evaluate the clinical utility of the identified profiles by examining their association with injury characteristics, neuropsychological outcomes, and clinical management-related outcomes.

The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium.

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes.

Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport.

Utility of Structured Oculomotor, Balance, and Exercise Testing in Civilian Adults With Mild Traumatic Brain Injury.

Purpose: Assessments of oculomotor, balance, and exercise function detect different responses to mild traumatic brain injury in sports-related mild traumatic brain injury. These assessments are understudied in the adult community mild traumatic brain injury population. We evaluated level 1 trauma center patients with nonsports-related mild traumatic brain injury on oculomotor functioning (near point of convergence and accommodation), balance (Balance Error Scoring System), and exercise tolerance (Buffalo Concussion Treadmill Test).

Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study.

Introduction: Mild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI symptoms relate to each other. The centrality hypothesis of network theory posits that certain symptoms in a network are more relevant (central) or have above average influence over the rest of the network.

Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery: A TRACK-TBI Study.

Importance: Traumatic brain injury (TBI) is associated with persistent functional and cognitive deficits, which may be susceptible to secondary insults. The implications of exposure to surgery and anesthesia after TBI warrant investigation, given that surgery has been associated with neurocognitive disorders.

Objective: To examine whether exposure to extracranial (EC) surgery and anesthesia is related to worse functional and cognitive outcomes after TBI.

Data-driven distillation and precision prognosis in traumatic brain injury with interpretable machine learning.

Traumatic brain injury (TBI) affects how the brain functions in the short and long term. Resulting patient outcomes across physical, cognitive, and psychological domains are complex and often difficult to predict. Major challenges to developing personalized treatment for TBI include distilling large quantities of complex data and increasing the precision with which patient outcome prediction (prognoses) can be rendered.

Longitudinal Recovery Following Repetitive Traumatic Brain Injury.

Importance: One traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited.

Objective: To investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years.

Plasma phosphorylated tau181 as a biomarker of mild traumatic brain injury: findings from THINC and NCAA-DoD CARE Consortium prospective cohorts.

Objective: The aim of this study was to investigate phosphorylated tau (p-tau181) protein in plasma in a cohort of mild traumatic brain injury (mTBI) patients and a cohort of concussed athletes.

Methods: This pilot study comprised two independent cohorts. The first cohort-part of a Traumatic Head Injury Neuroimaging Classification (THINC) study-with a mean age of 46 years was composed of uninjured controls (UIC, = 30) and mTBI patients ( = 288) recruited from the emergency department with clinical computed tomography (CT) and research magnetic resonance imaging (MRI) findings.