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Emergency Care and Diagnostics in Patients with Traumatic Brain Injury
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Emergency Care and Diagnostics in Patients with Traumatic Brain Injury

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (20 November 2023) | Viewed by 6044

Special Issue Editors

Prof. Dr. Joukje Van der Naalt

E-Mail Website
Guest Editor
Department of Neurology AB51, University Medical Center Groningen, Groningen, The Netherlands
Interests: traumatic brain injury; serum biomarkers; imaging (f)MRI; outcome; behavior; cognition
Dr. Bram Jacobs

E-Mail Website
Guest Editor
Department of Neurology AB51, University Medical Center Groningen, Groningen, The Netherlands
Interests: traumatic brain injury; serum biomarkers; imaging (f)MRI; outcome; behavior; cognition

Special Issue Information

Dear Colleagues,

This Special Issue will focus on the emergency care and early diagnostics of traumatic brain injury (TBI). TBI is one of the major causes of morbidity worldwide. The primary treatment at the emergency department (ED) focusses on the prevention of secondary injury. After discharge, one in three patients will experience impairments interfering with the resumption of pre-injury activities and/or work. Taking the total number of patients with the increasing older adult population into account, the health care and societal injury related costs are high. The early identification and treatment of patients at risk of unfavorable outcome is of utmost importance. For the clinical assessment and early diagnosis of TBI at the ED, multimodal data including serum biomarkers and imaging are increasingly used to determine risk labels for incomplete recovery. Data from patient cohorts with mild-to-severe TBI can increase insight into the recovery patterns and key factors determining outcome, thus providing the opportunity to enhance patient care.

Prof. Dr. Joukje Van der Naalt
Dr. Bram Jacobs
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • traumatic brain injury
  • acute care
  • diagnosis
  • imaging
  • biomarkers
  • outcome
  • risk factors

Published Papers (4 papers)

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Research

16 pages, 1320 KiB  
Article
Classification and Characterization of Traumatic Brain Injuries in the Northern Region of Sweden
by Beatrice M. Magnusson and Lars-Owe D. Koskinen
J. Clin. Med. 2024, 13(1), 8; https://doi.org/10.3390/jcm13010008 - 19 Dec 2023
Viewed by 696
Abstract
Background: Traumatic brain injury (TBI) is a common cause of death and disability, the incidence of which in northern Sweden is not fully investigated. This study classifies and characterize epidemiological and demographic features of TBIs in a defined population in Umeå county, Sweden. [...] Read more.
Background: Traumatic brain injury (TBI) is a common cause of death and disability, the incidence of which in northern Sweden is not fully investigated. This study classifies and characterize epidemiological and demographic features of TBIs in a defined population in Umeå county, Sweden. Specifically, to evaluate frequencies of (1) intracranial lesions detected with computed tomography (CT), (2) need for emergency intervention, and (3) hospital admission, in minimal, mild, moderate, and severe TBI, respectively. Methods: The data were gathered from 4057 TBI patients visiting our emergency room (ER) during a two-year period (2015–2016), of whom 56% were men and approximately 95% had minimal TBIs (Glasgow Coma Scale (GCS), score 15). Results: Of all injuries, 97.8% were mild (GCS 14–15), 1.7% were moderate (GCS 9–13), and 0.5% were severe (GCS < 9). CT scans were performed on 46% of the patients, with 28% being hospitalized. A high annual TBI incidence of 1350 cases per 100,000 citizens was found. The mortality rate was 0.5% with the majority as expected in the elderly group (>80 years). Conclusions: Minimal TBIs were not as mild as previously reported, with a relatively high frequency of abnormal CT findings and a high mortality rate. No emergency intervention was required in patients in the GCS 13–15 group with normal CT scans. These findings have implications for clinical practice in the ER with the suggestion to include biomarkers to reduce unnecessary CT scans. Full article
(This article belongs to the Special Issue Emergency Care and Diagnostics in Patients with Traumatic Brain Injury)
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11 pages, 386 KiB  
Article
Venous Thrombus Embolism in Polytrauma: Special Attention to Patients with Traumatic Brain Injury
by Deng Chen, Jialiu Luo, Cong Zhang, Liangsheng Tang, Hai Deng, Teding Chang, Huaqiang Xu, Miaobo He, Dongli Wan, Feiyu Zhang, Mengfan Wu, Min Qian, Wen Zhou, Gang Yin, Wenguo Wang, Liming Dong and Zhaohui Tang
J. Clin. Med. 2023, 12(5), 1716; https://doi.org/10.3390/jcm12051716 - 21 Feb 2023
Cited by 1 | Viewed by 1411
Abstract
Venous thrombus embolism (VTE) is common after polytrauma, both of which are considered significant contributors to poor outcomes and mortality. Traumatic brain injury (TBI) is recognized as an independent risk factor for VTE and one of the most common components of polytraumatic injuries. [...] Read more.
Venous thrombus embolism (VTE) is common after polytrauma, both of which are considered significant contributors to poor outcomes and mortality. Traumatic brain injury (TBI) is recognized as an independent risk factor for VTE and one of the most common components of polytraumatic injuries. Few studies have assessed the impact of TBI on the development of VTE in polytrauma patients. This study sought to determine whether TBI further increases the risk for VTE in polytrauma patients. A retrospective, multi-center trial was performed from May 2020 to December 2021. The occurrence of venous thrombosis and pulmonary embolism from injury to 28 days after injury was observed. Of 847 enrolled patients, 220 (26%) developed DVT. The incidence of DVT was 31.9% (122/383) in patients with polytrauma with TBI (PT + TBI group), 22.0% (54/246) in patients with polytrauma without TBI (PT group), and 20.2% (44/218) in patients with isolated TBI (TBI group). Despite similar Glasgow Coma Scale scores, the incidence of DVT in the PT + TBI group was significantly higher than in the TBI group (31.9% vs. 20.2%, p < 0.01). Similarly, despite no difference in Injury Severity Scores between the PT + TBI and PT groups, the DVT rate was significantly higher in the PT + TBI group than in the PT group (31.9% vs. 22.0%, p < 0.01). Delayed anticoagulant therapy, delayed mechanical prophylaxis, older age, and higher D-dimer levels were independent predictive risk factors for DVT occurrence in the PT + TBI group. The incidence of PE within the whole population was 6.9% (59/847). Most patients with PE were in the PT + TBI group (64.4%, 38/59), and the PE rate was significantly higher in the PT + TBI group compared to the PT (p < 0.01) or TBI (p < 0.05) group. In conclusion, this study characterizes polytrauma patients at high risk for VTE occurrence and emphasizes that TBI markedly increases the incidence of DVT and PE in polytrauma patients. Delayed anticoagulant therapy and delayed mechanical prophylaxis were identified as the major risk factors for a higher incidence of VTE in polytrauma patients with TBI. Full article
(This article belongs to the Special Issue Emergency Care and Diagnostics in Patients with Traumatic Brain Injury)
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14 pages, 433 KiB  
Article
Evaluation of Clinical Characteristics and CT Decision Rules in Elderly Patients with Minor Head Injury: A Prospective Multicenter Cohort Study
by Sophie M. Coffeng, Kelly A. Foks, Crispijn L. van den Brand, Korné Jellema, Diederik W. J. Dippel, Bram Jacobs and Joukje van der Naalt
J. Clin. Med. 2023, 12(3), 982; https://doi.org/10.3390/jcm12030982 - 27 Jan 2023
Cited by 2 | Viewed by 1761
Abstract
Age is variably described as a minor or major risk factor for traumatic intracranial lesions after head injury. However, at present, no specific CT decision rule is available for elderly patients with minor head injury (MHI). The aims of this prospective multicenter cohort [...] Read more.
Age is variably described as a minor or major risk factor for traumatic intracranial lesions after head injury. However, at present, no specific CT decision rule is available for elderly patients with minor head injury (MHI). The aims of this prospective multicenter cohort study were to assess the performance of existing CT decision rules for elderly MHI patients and to compare the clinical and CT characteristics of elderly patients with the younger MHI population. Thirty-day mortality between two age groups (cutoff ≥ 60 years), along with clinical and CT characteristics, was evaluated with four CT decision rules: the National Institute for Health and Care Excellence (NICE) guideline, the Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), and the CT Head Injury Patients (CHIP) rule. Of the 5517 MHI patients included, 2310 were aged ≥ 60 years. Elderly patients experienced loss of consciousness (17% vs. 32%) and posttraumatic amnesia (23% vs. 31%) less often, but intracranial lesions (13% vs. 10%), neurological deterioration (1.8% vs. 0.2%), and 30-day mortality (2.0% vs. 0.1%) were more frequent than in younger patients (all p < 0.001). Elderly patients with age as their only risk factor showed intracranial lesions in 5% (NOC and CHIP) to 8% (CCHR and NICE) of cases. The sensitivity of decision rules in the elderly patients was 60% (CCHR) to 97% (NOC) when age was excluded as a risk factor. Current risk factors considered when evaluating elderly patients show lower sensitivity to identify intracranial abnormalities, despite more frequent intracranial lesions. Until age-specific CT decision rules are developed, it is advisable to scan every elderly patient with an MHI. Full article
(This article belongs to the Special Issue Emergency Care and Diagnostics in Patients with Traumatic Brain Injury)
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18 pages, 1141 KiB  
Article
Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study
by Daniel Vieira de Oliveira, Rita de Cássia Almeida Vieira, Leonardo Zumerkorn Pipek, Regina Marcia Cardoso de Sousa, Camila Pedroso Estevam de Souza, Eduesley Santana-Santos and Wellingson Silva Paiva
J. Clin. Med. 2022, 11(21), 6466; https://doi.org/10.3390/jcm11216466 - 31 Oct 2022
Cited by 3 | Viewed by 1552
Abstract
Objective: The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within [...] Read more.
Objective: The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL. Methodology: This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI. RESULTS: The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence. Conclusions: Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence. Full article
(This article belongs to the Special Issue Emergency Care and Diagnostics in Patients with Traumatic Brain Injury)
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