Quality of life and neuropsychological changes in mild head trauma - Late analysis and correlation with S100B protein and cranial CT scan performed at hospital admission
Research Division, Heart Institute, InCor, University of São Paulo School of Medicine, São Paulo, Brazil. Injury
(Impact Factor: 2.14).
06/2008; 39(5):604-11. DOI: 10.1016/j.injury.2007.11.008
mild head trauma (MHT) is defined as a transient neurological deficit after trauma with a history of impairment or loss of consciousness lasting less than 15 min and/or posttraumatic amnesia, and a Glasgow Coma Scale between 13 and 15 on hospital admission. We evaluated 50 MHT patients 18 months after the trauma, addressing signs and symptoms of post-concussion syndrome, quality of life and the presence of anxiety and depression. We correlate those findings with the S100B protein levels and cranial CT scan performed at hospital admission after the trauma.
patients were asked to fill out questionnaires to assess quality of life (SF36), anxiety and depression (HADS), and signs and symptoms of post-concussion syndrome. For the control group, we asked the patient's household members, who had no history of head trauma of any type, to answer the same questionnaires for comparison.
total quality of life index for patients with MHT was 58.16 (+/-5), lower than the 73.47 (+/-4) presented by the control group. Twenty patients (55.2%) and four (11.1%) controls were depressed. Seventeen patients (47.2%) presented anxiety, whereas only eight (22.2%) controls were considered anxious. Victims of MHT complained more frequently of loss of balance, dry mouth, pain in the arms, loss of memory and dizziness than their respective controls (p<0.05). We found no correlation between the presence of these signs and symptoms, quality of life, presence of anxiety and depression with S100B protein levels or with presence of injury in the cranial CT performed at hospital admission.
MHT is associated with a higher incidence of post-concussion syndrome symptoms, lower quality of life and anxiety than their respective controls even 18 months after the trauma.
Available from: Ewout W Steyerberg
- "Research has shown that even years after injury, many TBI patients still report significantly lower HRQL than the general population [1,2,11–14]. Most studies however, focus on recovery after mild    or moderate and severe      TBI. HRQL and recovery pattern differences between mild, moderate and severe TBI are not often studied. "
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The Glasgow Outcome Scale Extended (GOSE) is the established functional outcome scale to assess disability following traumatic brain injury (TBI), however does not capture the patient's subjective perspective. Health-related quality of life (HRQL) does capture the individual's perception of disability after TBI, and has therefore been recognized as an important outcome in TBI. In contrast to GOSE, HRQL enables comparison of health outcome across various disease states and with healthy individuals. We aimed to assess functional outcome, HRQL, recovery, and predictors of 6 and 12-month outcome in a comprehensive sample of patients with mild, moderate or severe TBI, and to examine the relationship between functional impairment (GOSE) and HRQL.
A prospective cohort study was conducted among a sample of 2066 adult TBI patients who attended the emergency department (ED). GOSE was determined through questionnaires or structured interviews. Questionnaires 6 and 12 months after ED treatment included socio-demographic information and HRQL measured with Short-Form Health Survey (SF-36; reflecting physical, mental and social functioning) and Perceived Quality of Life Scale (PQoL; measuring degree of satisfaction with functioning).
996 TBI survivors with mild, moderate or severe TBI completed the 6-month questionnaire. Functional outcome and HRQL after moderate or severe TBI was significantly lower than after mild TBI. Patients with moderate TBI showed greatest improvement. After one year, the mild TBI group reached outcomes comparable to population norms. TBI of all severities highly affected SF-36 domains physical and social functioning, and physical and emotional role functioning. GOSE scores were highly related to all SF-36 domains and PQoL scores. Female gender, older age, co-morbidity and high ISS were strongest independent predictors of decreased HRQL at 6 and 12 months after TBI.
HRQL and recovery patterns differ for mild, moderate and severe TBI. This study indicates that GOSE, although clinically relevant, fails to capture the subjective perspective of TBI patients, which endorses the use of HRQL as valuable addition to established instruments in assessing disability following TBI. Influence of TBI severity on recovery, together with female gender, older age, co-morbidity and high ISS should be considered in long-term follow-up and intervention programs.
Injury 11/2014; 46(4). DOI:10.1016/j.injury.2014.10.064 · 2.14 Impact Factor
Available from: Wellingson Silva Paiva
- "Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic brain injury (TBI), is considered one of the most prevalent forms of primary neuronal injury in patients with severe TBI.1,2 Head injuries typically induce transient cognitive deficits;3 however, these aberrations may persist following moderate or severe injuries. Cognitive processes that may be affected by TBI include mental flexibility, attention, set-shifting, planning, organization, sequencing, judgment, verbal fluency (VF), working memory, and impulsivity.4 "
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ABSTRACT: Background: Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic brain injury (TBI), is considered one of the most prevalent forms of primary neuronal injury in patients with severe TBI. Cognitive deficits induced by DAI can persist over time, especially following moderate or severe injuries. The aim of the present study was to compare verbal fluency (VF) performance at 6 and 12 months after the trauma in a same group of patients with DAI.
Methods: Eighteen patients with moderate to severe DAI and 17 healthy volunteers were enrolled. All DAI participants had sustained a TBI at least 6 months prior to the start of the study, were between 18 and 50 years of age, and had at least 4 years of education. The VF test was administered within an extensive neuropsychological test battery. We evaluated the same patients at 6 months (DAI1 group) and 12 months (DAI2 group) and compared the results of neuropsychological tests with a control group of healthy volunteers who were matched to patients for sex, age, and educational level.
Results: In comparison to controls, the DAI1 group produced significantly fewer words. The DAI2 group produced significantly more semantic words than DAI1 (P0.05) and demonstrated a trend towards the production of more clusters for letter A (P=0.09) and total words generated in a phonemic test (P=0.09). No significant differences were observed between DAI2 and the control group in the total number of words generated in phonetic FAS or semantic fluency scores. Conclusion: The present findings may be useful in the construction of a management plan for long-term TBI rehabilitation that considers the trauma of each patient. Further, our results suggest the VF test is a suitable instrument for the assessment of cognitive difficulties following TBI.
Neuropsychiatric Disease and Treatment 06/2014; 10:1155-1160. DOI:10.2147/NDT.S62728 · 1.74 Impact Factor
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ABSTRACT: Concussion is a physiological injury to the extremely complex and dynamic human brain. Individual variability adds to the challenge of concussion management, and sports medicine practitioners recently have begun to realize the need for an individualized approach. Adequately assessing an athlete with concussion requires consideration of many risk factors, including age, gender, and certain comorbid conditions. Understanding how these factors may affect concussion risk and outcome is becoming an essential aspect of management. This article reviews what is known or assumed about how some of these risk factors affect concussion. We conclude by providing several key concepts that we feel are important to keep in mind when managing an athlete with concussion.
Current Sports Medicine Reports 01/2010; 9(1):16-20. DOI:10.1249/JSR.0b013e3181caa89d · 1.55 Impact Factor
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