Journal ArticleDOI
Prognostic Value of Demographic Characteristics in Traumatic Brain Injury: Results from The IMPACT Study
Nino A Mushkudiani,Doortje C. Engel,Ewout W. Steyerberg,Isabella Butcher,Juan Lu,Anthony Marmarou,Frans J A Slieker,Gillian S McHugh,Gordon D Murray,Andrew I R Maas +9 more
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TLDR
It is concluded that outcome following TBI is dependent on age, race, to a lesser extent on education, but not on gender, and the prognostic effect of race and education were sustained.Abstract:
Outcome following traumatic brain injury (TBI) is not only dependent on the nature and severity of injury and subsequent treatment, but also on constituent characteristics of injured individuals. We aimed to describe and quantify the relationship between demographic characteristics and six month outcome assessed by the Glasgow Outcome Scale (GOS) after TBI. Individual patient data on age (n = 8719), gender (n = 8720), race (n = 5320), and education (n = 2201) were extracted from eight therapeutic Phase III randomized clinical trials and three surveys in moderate or severe TBI, contained in the IMPACT database. The strength of prognostic effects was analyzed with binary and proportional odds regression analysis and expressed as an odds ratio. Age was analyzed as a continuous variable with spline functions, and the odds ratio calculated over the difference between the 75 th and 25 th percentiles. Associations with other predictors were explored. Increasing age was strongly related to poorer outcome (OR 2.14; 95% CI 2.00-2.28) in a continuous fashion that could be approximated by a linear function. No gender differences in outcome were found (OR: 1.01; CI 0.92-1.11), and exploratory analysis failed to show any gender/age interaction. The studies included predominantly Caucasians (83%); outcome in black patients was poorer relative to this group (OR 1.30; CI 1.09-1.56). This relationship was sustained on adjusted analyses, and requires further study into mediating factors. Higher levels of education were weakly related to a better outcome (OR: 0.70; CI 0.52-0.94). On multivariable analysis adjusting for age, motor score, and pupils, the prognostic effect of race and education were sustained. We conclude that outcome following TBI is dependent on age, race, to a lesser extent on education, but not on gender.read more
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Journal ArticleDOI
Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research
Andrew I R Maas,David K. Menon,P. David Adelson,Nada Andelic,Michael J. Bell,Antonio Belli,Peter Bragge,Alexandra Brazinova,Andras Buki,Randall M. Chesnut,Giuseppe Citerio,Mark Coburn,D. Jamie Cooper,A Tamara Crowder,Endre Czeiter,Marek Czosnyka,Ramon Diaz-Arrastia,Jens P. Dreier,Ann-Christine Duhaime,Ari Ercole,Thomas A. van Essen,Valery L. Feigin,Guoyi Gao,Joseph T. Giacino,Laura E. Gonzalez-Lara,Russell L. Gruen,Russell L. Gruen,Deepak Gupta,Jed A. Hartings,Sean Hill,Jiyao Jiang,Naomi Ketharanathan,Erwin J. O. Kompanje,Linda Lanyon,Steven Laureys,Fiona Lecky,Harvey S. Levin,Hester F. Lingsma,Marc Maegele,Marek Majdan,Geoffrey T. Manley,Jill A. Marsteller,Luciana Mascia,Charles McFadyen,Stefania Mondello,Virginia F. J. Newcombe,Aarno Palotie,Aarno Palotie,Aarno Palotie,Paul M. Parizel,Wilco C. Peul,James Piercy,Suzanne Polinder,Louis Puybasset,Todd E. Rasmussen,Rolf Rossaint,Peter Smielewski,Jeannette Söderberg,Simon J. Stanworth,Murray B. Stein,Nicole von Steinbüchel,William Stewart,Ewout W. Steyerberg,Ewout W. Steyerberg,Nino Stocchetti,Anneliese Synnot,Anneliese Synnot,Braden Te Ao,Olli Tenovuo,Alice Theadom,Dick Tibboel,Walter Videtta,Kevin K.W. Wang,W. Huw Williams,Lindsay Wilson,Kristine Yaffe,Hadie Adams,Vanni Agnoletti,Judith Allanson,Krisztina Amrein,Norberto Andaluz,Audny Anke,Anna Antoni,Arjan Bastiaan van As,Gérard Audibert,Antun Azaševac,Philippe Azouvi,Maria Luisa Azzolini,Camelia Baciu,Rafael Badenes,Karen M. Barlow,Ronald H. M. A. Bartels,Ursula Bauerfeind,Miriam H. Beauchamp,Darcy Beer,Ronny Beer,Francisco Javier Belda,Bo-Michael Bellander,Rémy Bellier,Habib Benali,Thierry Benard,Valzerda Beqiri,Luigi Beretta,Francis Bernard,Guido Bertolini,Federico Bilotta,Morten Blaabjerg,Hugo den Boogert,Kathy Boutis,Pierre Bouzat,Brian L. Brooks,Camilla Brorsson,Monika Bullinger,Emma Burns,Calappi E,Peter Cameron,Elsa Carise,Ana M. Castaño-Leon,Francesco Causin,Giorgio Chevallard,Arturo Chieregato,Brian R. Christie,Maryse C. Cnossen,Jonathan P. Coles,Johnny Collett,Francesco Della Corte,William Craig,Gábor Csató,Ákos Csomós,Nicola Curry,Claire Dahyot-Fizelier,Helen Dawes,Carol DeMatteo,Bart Depreitere,Deborah Dewey,Jeroen T. J. M. van Dijck,Đula Đilvesi,Diederik W.J. Dippel,Kemal Dizdarevic,Emma Donoghue,Or Duek,Guy-Loup Dulière,Adelaida Dzeko,George A. Eapen,Carolyn A. Emery,Shane W. English,Patrick Esser,Erzsébet Ezer,Martin Fabricius,Junfeng Feng,Dean Fergusson,Anthony Figaji,Joanne Fleming,Kelly A Foks,G. Francony,Stephen B. Freedman,Ulderico Freo,Shirin Frisvold,Isabelle Gagnon,Damien Galanaud,Dashiell Gantner,Benoit Giraud,Ben Glocker,Jagos Golubovic,Pedro A Gómez López,Wayne A. Gordon,Primoz Gradisek,Jocelyn Gravel,Donald E. G. Griesdale,Francesca Grossi,Juanita A. Haagsma,Asta Håberg,Iain K. Haitsma,Wim Van Hecke,Raimund Helbok,Eirik Helseth,Caroline M. van Heugten,Cornelia W. E. Hoedemaekers,Stefan Höfer,Lindsay Horton,Jiyuan Hui,Jilske A Huijben,Peter J. Hutchinson,Bram Jacobs,Mathieu van der Jagt,Stefan Jankowski,Koen Janssens,Bojan Jelaca,Kelly Jones,Konstantinos Kamnitsas,Rafael Kaps,Mladen Karan,Ari Katila,Kirsi-Maija Kaukonen,Véronique De Keyser,Riku Kivisaari,Angelos G. Kolias,Balint Kolumban,Ksenija Kolundžija,Daniel Kondziella,Lars-Owe D. Koskinen,Noémi Kovács,Andreas H. Kramer,Demitri Kutsogiannis,Theodoros Kyprianou,Alfonso Lagares,Francois Lamontagne,Roberto Latini,François Lauzier,Isaac Lazar,Christian Ledig,Rolf Lefering,Valerie Legrand,Leon Levi,Roger Lightfoot,Angels Lozano,Stephen MacDonald,Sebastian Major,Alex Manara,Pauline Manhes,Hugues Maréchal,Costanza Martino,Alessandro Masala,Serge Masson,Julia Mattern,Bradford J. McFadyen,Catherine McMahon,Maureen O. Meade,Béla Melegh,Tomas Menovsky,Lynne Moore,Marta M Correia,Maria Cristina Morganti-Kossmann,Holger Muehlan,Pratik Mukherjee,Lynnette Murray,Joukje van der Naalt,Ancuta Negru,David W. Nelson,Daan Nieboer,Quentin Noirhomme,József Nyirádi,Mauro Oddo,David O. Okonkwo,Annemarie W. Oldenbeuving,Fabrizio Ortolano,Martin H. Osmond,Jean-François Payen,Vincent Perlbarg,Paolo Persona,Nicolas Pichon,Anna Piippo-Karjalainen,Sebastien Pili-Floury,Matti Pirinen,Horia Ple,Maria A. Poca,Jussi P. Posti,Dominique Van Praag,Alain Ptito,Andreea Radoi,Arminas Ragauskas,Arminas Ragauskas,Rahul Raj,Ruben G. L. Real,Nick Reed,Jonathan Rhodes,Claudia S. Robertson,Saulius Rocka,Saulius Rocka,Cecilie Røe,Olav Røise,Gerwin Roks,Jonathan Rosand,Jeffrey V. Rosenfeld,Christina Rosenlund,Guy Rosenthal,Sandra Rossi,Daniel Rueckert,Godard C.W. de Ruiter,Marco Sacchi,Barbara J. Sahakian,Juan Sahuquillo,Oliver W. Sakowitz,Gerardo Salvato,Renán Sánchez-Porras,János Sándor,Grinder Sangha,Nadine Schäfer,Silke Schmidt,Kathryn J Schneider,David M. Schnyer,Herbert Schöhl,Guus G. Schoonman,Rico Frederik Schou,Özcan Sir,Toril Skandsen,Dirk Smeets,Abayomi Sorinola,Emmanuel Stamatakis,Ana Stevanovic,Robert Stevens,Nina Sundström,Fabio Silvio Taccone,Fabio Silvio Taccone,Riikka S.K. Takala,Päivi Tanskanen,Mark Taylor,Ralph Telgmann,Nancy R. Temkin,Guido Teodorani,Matthew Thomas,Christos M. Tolias,Tony Trapani,Alexis F. Turgeon,Peter Vajkoczy,Alex B. Valadka,Egils Valeinis,Shirley Vallance,Zoltan Vamos,Alessia Vargiolu,Emmanuel Vega,Jan Verheyden,Anne Vik,Rimantas Vilcinis,Carmen L.A. Vleggeert-Lankamp,Lidia Vogt,Victor Volovici,Daphne C. Voormolen,Peter Vulekovic,Thijs Vande Vyvere,Julia Van Waesberghe,Lars Wessels,Eno Wildschut,Guy B. Williams,Maren K.L. Winkler,Stefan Wolf,Gordon Wood,Nektaria Xirouchaki,Alexander Younsi,Menashe Zaaroor,Veronika Zelinkova,Roger Zemek,Fabrizio Zumbo +342 more
TL;DR: The InTBIR Participants and Investigators have provided informed consent for the study to take place in Poland.
Journal ArticleDOI
Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study.
Gordon D Murray,Isabella Butcher,Gillian S McHugh,Juan Lu,Nino A Mushkudiani,Andrew I R Maas,Anthony Marmarou,Ewout W. Steyerberg +7 more
TL;DR: The results provide pointers to future research, including further analysis of the prognostic value of prothrombin time, and the evaluation of the clinical impact of intervening aggressively to correct abnormalities in hemoglobin, glucose, and coagulation.
Journal ArticleDOI
Early prognosis in traumatic brain injury: from prophecies to predictions
TL;DR: Two prediction models are currently available, both of which have been developed on large datasets with state-of-the-art methods, and offer new opportunities for their use in clinical practice, research, and policy making, as well as for assessment of the quality of health-care delivery.
Journal ArticleDOI
Traumatic Intracranial Hypertension
Nino Stocchetti,Andrew I R Maas +1 more
TL;DR: The methods of monitoring and treating traumatic intracranial hypertension in intensive care settings and how these are applied to patients in accident and emergency departments are reviewed.
Journal ArticleDOI
Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions.
TL;DR: There is an urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatrics TBI prognostic models, and evidence-based geriatric-specific TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatricTBI population.
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Journal ArticleDOI
Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study.
Gordon D Murray,Isabella Butcher,Gillian S McHugh,Juan Lu,Nino A Mushkudiani,Andrew I R Maas,Anthony Marmarou,Ewout W. Steyerberg +7 more
TL;DR: The results provide pointers to future research, including further analysis of the prognostic value of prothrombin time, and the evaluation of the clinical impact of intervening aggressively to correct abnormalities in hemoglobin, glucose, and coagulation.
Journal ArticleDOI
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Raj K. Narayan,Richard P. Greenberg,J D Miller,Gregory G. Enas,Sung C. Choi,P. R. S. Kishore,John B. Selhorst,H. A. Lutz,D. P. Becker +8 more
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