Incidence and Associated Factors of Anemia in Patients with Acute Moderate and Severe Traumatic Brain Injury

Background Anemia might contribute to the development of secondary injury in patients with acute traumatic brain injury (TBI). Potential determinants of anemia are still poorly acknowledged, and reported incidence of declined hemoglobin concentration varies widely between different studies. The aim of this study was to investigate the incidence of severe anemia among patients with moderate to severe TBI and to evaluate patient- and trauma-related factors that might be associated with the development of anemia. Methods This retrospective cohort study involved all adult patients admitted to Tampere University Hospital's emergency department for moderate to severe TBI (August 2010 to July 2012). Detailed information on patient demographics and trauma characteristics were obtained, including data on posttraumatic care, data on neurosurgical procedures, and all measured in-hospital hemoglobin values. Severe anemia was defined as a hemoglobin level less than 100 g/L. Both univariate and multivariable analyses were performed, and hemoglobin trajectories were created. Results The study included 145 patients with moderate to severe TBI (male 83.4%, mean age 55.0 years). Severe anemia, with a hemoglobin level less than 100 g/L, was detected in 66 patients (45.5%) and developed during the first 48 h after the trauma. In the univariate analysis, anemia was more common among women (odds ratio [OR] 2.84; 95% confidence interval [CI] 1.13-7.15), patients with antithrombotic medication prior to trauma (OR 3.33; 95% CI 1.34-8.27), patients with cardiovascular comorbidities (OR 3.12; 95% CI 1.56-6.25), patients with diabetes (OR 4.56; 95% CI 1.69-12.32), patients with extracranial injuries (OR 3.14; 95% CI 1.69-12.32), and patients with midline shift on primary head computed tomography (OR 2.03; 95% CI 1.03-4.01). In the multivariable analysis, midline shift and extracranial traumas were associated with the development of severe anemia (OR 2.26 [95% CI 1.05-4.48] and OR 4.71 [95% CI 1.74-12.73], respectively). Conclusions Severe anemia is common after acute moderate to severe TBI, developing during the first 48 h after the trauma. Possible anemia-associated factors include extracranial traumas and midline shift on initial head computed tomography.Peer reviewe

Miten tunnistan ja hoidan lievän aivovamman

VertaisarvioituTavallisin syy aivovammaan on kaatuminen ja suurin osa vammoista on lieviä. Alkuvaiheessa tärkeintä on sulkea pois vakavan vamman mahdollisuus. Tapahtumatiedot, löydökset ja oireet kirjataan huolellisesti. Olennaisia ovat tajunnan muutokset, muistiaukko ja kuvantamislöydökset. Akuuttivaiheessa ensisijainen kuvantamismuoto on pään tietokonetomografia. Sillä voidaan sulkea pois vakavat kallonsisäiset verenvuodot. Toipumista voidaan edistää oireenmukaisella hoidolla ja potilasohjauksella. Ennuste on hyvä, mutta toipumisen pitkittyessä erikoissairaanhoidon arvio on usein tarpeen.Peer reviewe

Aivovammojen ali- ja ylidiagnostiikka

•Jokainen pään vamman saanut potilas ansaitsee asianmukaisen ja yhtenäisen diagnostiikan oikean hoidon ja kuntoutuksen saamiseksi. •Akuuttivaiheessa aivovammojen alidiagnostiikan riski on suurentunut erityisesti suurienergiaisissa ­tapaturmissa, joissa potilaan muut vakavat vammat vievät terveydenhuollon toimijoiden huomion. •Ylidiagnostiikkaa nähdään aivovammojen jälkitilojen arvioinnissa, kun potilaan oirekuvaa pidetään merkittävän aivovamman aiheuttamana riippumatta akuuttivaiheen tapahtumatiedoista ja muista selittävistä tekijöistä. •Kun diagnoosi on tehty alkuvaiheessa oikein, lievän aivovamman saaneista valtaosa toipuu ennalleen ja palaa töihin. Keskivaikea aivovamma voi aiheuttaa pitkittyneitä tai pysyviäkin toimintakykyä rajoittavia oireita, ja potilaat tarvitsevat kuntoutusta. Sitä vaikeamman aivovamman saaneet eivät yleensä kykene palaamaan työelämään.Peer reviewe

Tapaturmaisten aivovammojen epidemiologia muutoksessa – katse vanhempiin ikäluokkiin

Vanhusten tapaturmaisten aivovammojen lisääntyminen on kansanterveyden kannalta merkittävä trendi, joka näkyy myös meillä. Iäkkäiden naisten kuolleisuus aivovammoihin ja neuro­kirurgisia leikkauksia vaativien aivovammojen määrä ovat ­maassamme kasvussa. Vanhusten tapaturmat ovat usein ­kaatumisia, ja alkoholilla voi heilläkin olla osuutta asiaan.</p

How do we identify the crashing traumatic brain injury patient : the neurosurgeon's view

PURPOSE OF REVIEW: To provide an overview on recent advances in the field of assessment and monitoring of patients with severe traumatic brain injury (sTBI) in neurocritical care from a neurosurgical point of view. RECENT FINDINGS: In high-income countries, monitoring of patients with sTBI heavily relies on multimodal neurocritical parameters, nonetheless clinical assessment still has a solid role in decision-making. There are guidelines and consensus-based treatment algorithms that can be employed in both absence and presence of multimodal monitoring in the management of patients with sTBI. Additionally, novel dynamic monitoring options and machine learning-based prognostic models are introduced. Currently, the acute management and treatment of secondary injury/insults is focused on dealing with the objective evident pathology. An ongoing paradigm shift is emerging towards more proactive treatment of neuroworsening as soon as premonitory signs of deterioration are detected. SUMMARY: Based on the current evidence, serial clinical assessment, neuroimaging, intracranial and cerebral perfusion pressure and brain tissue oxygen monitoring are key components of sTBI care. Clinical assessment has a crucial role in identifying the crashing patient with sTBI, especially from a neurosurgical standpoint. Multimodal monitoring and clinical assessment should be seen as complementary evaluation methods that support one another.acceptedVersionPeer reviewe

CLU, CR1 and PICALM genes associate with Alzheimer's-related senile plaques

Introduction APOE is the strongest risk gene for sporadic Alzheimer's disease (AD) so far. Recent genome wide association studies found links for sporadic AD with CLU and CR1 involved in Aβ clearance, and PICALM affecting intracellular trafficking. Methods We investigated the associations of senile plaques (SP) and neurofibrillary tangles (NFT) with the proposed risk genes and APOE, in the Tampere Autopsy Study (TASTY) series (603 cases), a sample of the general population (0 to 97 yrs), who died out-of-hospital. Results Age and the APOEε4 allele associated strongly with all phenotypes of SP, as expected. In age and APOEε4 adjusted analyses, compared to the most common homozygous genotype, burnt out SP were more common among carriers of the C-allele of CLU, whereas the T-allele of PICALM and C-allele of CR1 were linked with lower SP coverage. We found no significant associations between any of the genetic variants and NFT. Conclusions Marginal effects from CLU, CR1 and PICALM suggest that these genes have minimal effects on the development of AD lesions.BioMed Central Open acces

Increasing incidence of pediatric mild traumatic brain injury in Finland - a nationwide register study from 1998 to 2018

Peer reviewe

Adolescent athletes with learning disability display atypical maturational trajectories on concussion baseline testing : Implications based on a Finnish sample

Previous research has reported lower cognitive test scores on baseline testing in athletes reporting multiple previous concussions or a history of learning disability (LD). Age also has an important influence on cognitive performance. While these factors have been considered individually in previous studies, the present study is the first to explore the interaction of age, self-reported LD, and history of concussion on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT (R)) in a nationwide study of adolescent athletes. ImPACT (R) was administered to 1823 Finnish male ice hockey players (aged 12-21 years old) prior to the 2015-2016 or 2016-2017 playing seasons. Linear regressions and simple slopes analyses were used for clarifying the impact of LD and previous concussion history on maturational trajectories. In comparison to typically developing athletes, athletes with LD had lower neurocognitive scores in all composites and differing maturational trajectory in verbal memory and visual motor speed. The number of previous concussions did not impair neurocognitive performance at baseline assessment. Application of standard age-based norms to adolescent athletes with a history of LD has the potential to negatively skew clinical decision-making. Separate reference values for LD athletes are warranted due to their unique developmental cognitive trajectories. The reference values for the Finnish participants in this study are presented.Peer reviewe

Risk for intracranial hemorrhage in individuals after mild traumatic brain injury who are taking serotonergic antidepressants

BackgroundSerotonergic antidepressants may predispose to bleeding, but little is known of the risk for traumatic intracranial bleeding. MethodsThis was a prospective case-control study of 218 patients with mild traumatic brain injuries (TBI) who were treated at a Finnish tertiary trauma hospital. Injury-related information and clinical findings were prospectively collected in the emergency department. Detailed pre-injury health history was collected from electronic medical records. Information on the use of serotonergic antidepressants was attained from the Finnish national prescription registry. All head CT scans were reviewed by a neuroradiologist based on the Common Data Elements. Cases were patients with traumatic intracranial hemorrhage on head CT. Controls were patients from the same cohort, but without traumatic intracranial lesions on CT. The proportion with traumatic intracranial bleeding for patients on serotonergic antidepressant medication was compared to the proportion for patients not on serotonergic medication. ResultsThe study cohort consisted of 24 cases with traumatic intracranial bleeding and 194 injured controls. The median age of the sample was 70 years (interquartile range = 50-83). One fifth (21.6%) of all the patients were taking a serotonergic antidepressant. Of the patients on an antidepressant, 10.6% (5/47) had an acute hemorrhagic lesion compared to 11.1% (19/171) of those who were not on an antidepressant (p = 0.927). In the regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use. ConclusionSerotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage after a mild TBI. The patients in this relatively small cohort were mostly middle-aged and older adults. These factors limit the generalizability of the results in younger patients with mild TBI.Peer reviewe