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Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic BrainInjury Clinical Practice Guidelines CATHERINE C. QUATMAN-YATES, PT , DPT , PhD • AIRELLE HUNTER-GIORDANO, PT , DPT KATHY K. SHIMAMURA, PT , DPT , NCS, OCS, CSCS, FAAOMPT • ROB LANDEL, PT , DPT , FAPTA BARA A. ALSALAHEEN, PT , PhD • TIMOTHY A. HANKE, PT , PhD • KAREN L. McCULLOCH, PT , PhD, FAPTA Physical Therapy Evaluation and Treatment After Concussion/ Mild Traumatic BrainInjury Clinical Practice Guidelines (...) experi- enced a recent potential concussive event for signs of medical emergency or severe pathology (eg, more serious braininjury, medical conditions, or cervical spine injury) that warrant further evaluation by other health care providers. Referral for fur- ther evaluation should be made as indicated (FIGURE 1). Differential Diagnosis A Physical therapists must evaluate for potential signs and symptoms of an undiagnosed concussion in patients who have experienced a concussive event but have
Tranexamic acid is safe to use following mild-to-moderate traumatic braininjury. The studyThe CRASH-3 Trial Collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic braininjury (CRASH-3): a randomised, placebo-controlled trial.Lancet 2019;394:1713-23.This trial was funded by NIHR Health Technology Assessment Programme (project number 14/190/01), JP Moulton Charitable Trust, Department of Health and Social (...) Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and the Wellcome Trust (Joint Global Health Trials scheme).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000870/tranexamic-acid-following-mild-to-moderate-traumatic-brain-injury-is-safe-and-reduces-deaths.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group
Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic braininjury (CRASH-3): a randomised, placebo-controlled trial. Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic braininjury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI.This (...) randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting
Feasibility and Accuracy of Fast MRI Versus CT for Traumatic BrainInjury in Young Children Computed tomography (CT) is commonly used for children when there is concern for traumatic braininjury (TBI) and is a significant source of ionizing radiation. Our objective was to determine the feasibility and accuracy of fast MRI (motion-tolerant MRI sequences performed without sedation) in young children.In this prospective cohort study, we attempted fast MRI in children <6 years old who had head CT (...) performed and were seen in the emergency department of a single, level 1 pediatric trauma center. Fast MRI sequences included 3T axial and sagittal T2 single-shot turbo spin echo, axial T1 turbo field echo, axial fluid-attenuated inversion recovery, axial gradient echo, and axial diffusion-weighted single-shot turbo spin echo planar imaging. Feasibility was assessed by completion rate and imaging time. Fast MRI accuracy was measured against CT findings of TBI, including skull fracture, intracranial
Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe braininjury in extremely preterm infants: observational cohort study with propensity score matching. To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes.Observational cohort study with propensity score matching.National health service neonatal care in England; population data held in the National Neonatal Research Database.Extremely (...) of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio.Death, severe braininjury, and survival without severe braininjury.2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly
Integrated Care Models for Acquired BrainInjury: Clinical Effectiveness, Cost-Effectiveness and Guidelines Integrated Care Models for Acquired BrainInjury: Clinical Effectiveness, Cost-Effectiveness and Guidelines | CADTH.ca Find the information you need Integrated Care Models for Acquired BrainInjury: Clinical Effectiveness, Cost-Effectiveness and Guidelines Integrated Care Models for Acquired BrainInjury: Clinical Effectiveness, Cost-Effectiveness and Guidelines Last updated: May 21, 2019 (...) Project Number: RB1327-000 Product Line: Research Type: Non-Pharma Mental Health Intervention Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness of integrated care models for patients with acquired braininjury with mental health and/or substance use disorders compared to patients who do not have access to patient-centered care? What is the cost-effectiveness of integrated care models for patients with acquired braininjury with mental health
Care for Acquired BrainInjury and Concurrent Mental Health and Substance Use Issues Care for Acquired BrainInjury and Concurrent Mental Health and Substance Use Issues | CADTH.ca Find the information you need Care for Acquired BrainInjury and Concurrent Mental Health and Substance Use Issues Care for Acquired BrainInjury and Concurrent Mental Health and Substance Use Issues Last updated: October 11, 2019 Project Number: ES0339-000 Product Line: Result type: Report Expected Completion Date (...) : February 21, 2020 CADTH is undertaking an Environmental Scan of systems and services that are in place in Canada for caring for individuals affected by acquired braininjury (ABI) and concurrent mental health and/or substance use issues. This project is being conducted to help inform decision-making and support practice change to improve the health and well-being of people living with ABI and concurrent mental health and/or substance use issues. The key objectives of this Environmental Scan
Neuroprotection from acute braininjury in preterm infants Infants born at ≤32 +6 weeks gestation are at higher risk for intracranial ischemic and hemorrhagic injuries, which often occur in the first 72 hours postbirth. Antenatal strategies to reduce the incidence of acute braininjuries include administering maternal corticosteroids and prompt antibiotic treatment for chorioamnionitis. Perinatal strategies include delivery within a tertiary centre, delayed cord clamping, and preventing (...) hypothermia. Postnatal strategies include empiric treatment with antibiotics when chorioamnionitis is suspected, the cautious use of inotropes, the avoidance of blood PCO2 fluctuation, and neutral head positioning. Clinicians should be aware of the policies and procedures that, especially when combined, can provide neuroprotection for preterm infants. Keywords: Acute braininjury; Infant; Intraventricular hemorrhage; Neuroprotection; Neuroprotective strategies; Premature
Comparison of Effects of Manual and Mechanical Airway Clearance Techniques on Intracranial Pressure in Patients With Severe Traumatic BrainInjury on a Ventilator: Randomized, Crossover Trial Physical therapist intervention can play a significant role in the prevention of mechanical and infectious complications in patients with traumatic braininjury (TBI) who are mechanically ventilated.The objective of this study was to observe and compare the effects of manual and mechanical airway clearance (...) techniques on intracranial pressure (ICP) and hemodynamics in patients with severe TBI.The design was a prospective, randomized, crossover trial.The setting was a neurointensive care unit at a level 1 trauma center.Forty-six adult patients aged 18 to 75 years, of either sex, with severe TBI, receiving mechanical ventilatory support with continuous ICP monitoring, and undergoing regular airway clearance techniques participated in this study.Two techniques were performed by a single trained physical
Can the important braininjury criteria predict neurosurgical intervention in mild traumatic braininjury? A validation study. There is variability in the management of patients presenting to the emergency department (ED) with mild traumatic braininjury (MTBI) and abnormal findings on their initial head computed tomography (CT). The main objective of this study was to validate the value of the Important BrainInjury (IBI) criteria, introduced by the Canadian CT-Head Rule, in predicting
Detection of Brain Activation in Unresponsive Patients with Acute BrainInjury. Brain activation in response to spoken motor commands can be detected by electroencephalography (EEG) in clinically unresponsive patients. The prevalence and prognostic importance of a dissociation between commanded motor behavior and brain activation in the first few days after braininjury are not well understood.We studied a prospective, consecutive series of patients in a single intensive care unit who had acute (...) braininjury from a variety of causes and who were unresponsive to spoken commands, including some patients with the ability to localize painful stimuli or to fixate on or track visual stimuli. Machine learning was applied to EEG recordings to detect brain activation in response to commands that patients move their hands. The functional outcome at 12 months was determined with the Glasgow Outcome Scale-Extended (GOS-E; levels range from 1 to 8, with higher levels indicating better outcomes).A total
Message S100B serum biomarker has high sensitivity and negative predictive value for detecting traumatic intracranial lesions in children with mild traumatic braininjury. However, how to incorporate this into existing risk-stratification tools is unclear, and reduced availability of the test currently limits its practical application in the emergency department (ED). Methods Data Sources The authors searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus (...) . The 8 included studies comprised 601 children with mild traumatic braininjury who underwent serum S100B biomarker testing compared with head CT or clinical follow-up as the references standard. S100B levels for detecting traumatic intracranial lesions in children with mild traumatic braininjury had a pooled sensitivity of 100% (95% CI 98% to 100%) and negative predictive value of 100% (95% CI 99% to 100%), whereas the pooled specificity was 41% (95% CI 26% to 57%), with significant heterogeneity
Systematic Review - Relationship of Deployment-related Mild Traumatic BrainInjury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders 4 March 2019 Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence Synthesis Program (ESP) Center Portland VA Medical Center Portland, OR Mark Helfand, MD, MPH, MS, Director (...) Relationship of Deployment-related Mild Traumatic BrainInjury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders: A Systematic Review Authors: Principal Investigator: Nancy Greer, PhD Timothy J. Wilt, MD, MPH Co-Investigators: Princess Ackland, PhD, MSPH Roderick MacDonald, MS Nina Sayer, PhD Michele Spoont, PhD Brent Taylor, PhD Research Assistants: Lauren McKenzie, MPH Christina Rosebush, MPH Evidence Synthesis Program 4 Relationship
Evidence Brief: Traumatic BrainInjury and Dementia Management Briefs eBrief-no150 -- Traumatic BrainInjury and Dementia Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs eBrief-no150 -- Traumatic BrainInjury and Dementia Health Services Research & Development Management eBrief no. 150 » Issue 150 March 2019 The report is a product of the VA/HSR&D Evidence Synthesis Program. Evidence (...) Brief: Traumatic BrainInjury and Dementia Traumatic braininjury (TBI) is a common condition among both civilian and military populations. While some TBIs cause acute symptoms that resolve over several weeks or months, evidence accumulated over nearly three decades suggests that TBI may lead to chronic neurodegenerative diseases such as dementia. More public awareness about TBI in active-duty service members as a risk factor for earlier onset of dementia and/or of Chronic Traumatic Encephalopathy
. 1996;6(2):97-101. Ryan AJ. Intracranialinjuries resulting from boxing. Clin Sports Med. 1998;17(1):155-168. doi:10.1016/S0278-5919(05)70070-3. Blennow K, Hardy J, Zetterberg H. The neuropathology and neurobiology of traumatic braininjury. Neuron. 2012;76(5):886-899. doi:10.1016/j.neuron.2012.11.021. McCrory P, Feddermann-Demont N, Dvorak J, et al. What is the definition of sports-related concussion: a systematic review. Br J Sports Med. 2017;51(11):877–887. doi:10.1136/bjsports-2016-097393. Baugh (...) Is traumatic braininjury preventable in amateur boxing competition? Is Traumatic BrainInjury Preventable in Amateur Boxing Competition? – Clinical Correlations Search Is Traumatic BrainInjury Preventable in Amateur Boxing Competition? January 18, 2019 5 min read By Kevin Rezzadeh Peer Reviewed Injuries associated with amateur . 1 While many of the superficial wounds and bone fractures can completely heal, brain damage secondary to boxing has also been well 2 Boxers are at risk for sequelae
Traumatic BrainInjury and Dementia 4 February 2019 Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence Synthesis Program (ESP) Coordinating Center Portland VA Health Care System Portland, OR Mark Helfand, MD, MPH, MS, Director Evidence Brief: Traumatic BrainInjury and Dementia Authors: Kim Peterson, MS Stephanie Veazie, MPH Donald Bourne, MPH Johanna Anderson, MPH Evidence (...) , Veazie S, Bourne D, Anderson J. Evidence Brief: Traumatic BrainInjury and Dementia. VA ESP Project #09-199; 2019. Posted final reports are located on the ESP search page. This report is based on research conducted by the Evidence Synthesis Program (ESP) Center located at the Portland VA Health Care System, Portland, OR, funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. The findings and conclusions in this document are those
include the following: Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic braininjury in adults. Lancet Neurol. 2008 Aug;7(8):728-41. http://www.ncbi.nlm.nih.gov/pubmed/18635021?tool=bestpractice.com Cerebral oedema Increased intracranial pressure (ICP) Haemorrhage Seizures Ischaemia Infection. Epidemiology of TBI TBI is a substantial cause of morbidity and mortality, leading to more than 2 million accident and emergency department visits annually in the US, Coronado VG, McGuire LC (...) /pubmed/11356436?tool=bestpractice.com After traumatic braininjury, there is an inverse relationship between the GCS score and the incidence of positive findings on CT; in fact, the rate of intracranialinjury (ICI) and need for neurosurgical intervention doubles when the GCS drops from 15 to 14. Smits M, Dippel DW, Steyerberg EW, et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Ann Intern Med. 2007;146(6):397-405
Incidence of emergency department presentations for traumatic braininjury in Indigenous and non-Indigenous residents aged 15â€“64 over the 9-year period 2007â€“2015 in North Queensland, Australia Traumatic braininjury (TBI) is a leading cause of disability worldwide. Previous studies have shown that males have a higher incidence than females, and Indigenous populations have a higher rate than non-Indigenous. To date, no study has compared the incidence rate of TBI between Indigenous and non