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OBJECTIVE: This study compared rates of suicide attempt (SA) and suicidal ideation (SI) during the first 5 years after traumatic brain injury (TBI) among veterans and service members (V/SMs) in the Veterans Affairs (VA) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Model Systems National Databases to each other and to non-veterans (non-Vs) in the NIDILRR database. SETTING: Twenty-one NIDILRR and 5 VA TBI Model Systems (TBIMS) inpatient rehabilitation facilities in the United States. PARTICIPANTS: Participants with TBI were discharged from rehabilitation alive, had a known military status recorded (either non-V or history of military service), and successful 1-, 2-, and/or 5-year follow-up interviews completed between 2009 and 2021. The year 1 cohort included 8737 unique participants (8347 with SA data and 3987 with SI data); the year 2 (7628 participants) and year 5 (4837 participants) cohorts both had similar demographic characteristics to the year 1 cohort. DESIGN: Longitudinal design with data collected across TBIMS centers at 1, 2, and 5 years post-injury. MAIN OUTCOMES AND MEASURES: History of SA in past year and SI in past 2 weeks assessed by the Patient Health Questionnaire-9 (PHQ-9). Patient demographics, injury characteristics, and rehabilitation outcomes were also assessed. RESULTS: Full sample rates of SA were 1.9%, 1.5%, and 1.6%, and rates of SI were 9.6%, 10.1%, and 8.7% (respectively at years 1, 2, and 5). There were significant differences among groups based on demographic, injury-related, mental/behavioral health, and functional outcome variables. Characteristics predicting SA/SI related to mental health history, substance use, younger age, lower functional independence, and greater levels of disability. CONCLUSIONS: Compared with participants with TBI in the NIDILRR system, higher rates of SI among V/SMs with TBI in the VA system appear associated with risk factors observed within this group, including mental/behavioral health characteristics and overall levels of disability.
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OBJECTIVE: To investigate relative causality in relations among suicidal ideation (SI), depressive symptoms, and functional independence over the first 10 years after traumatic brain injury (TBI). DESIGN: Prospective longitudinal design with data collected through the Traumatic Brain Injury Model Systems (TBIMS) network at acute rehabilitation hospitalization as well as 1, 2, 5, and 10 years after injury. SETTING: United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. PARTICIPANTS: Individuals enrolled into the TBIMS National Database (N=9539) with at least 1 SI score at any follow-up data collection (72.1% male; mean age, 39.39y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient Health Questionnaire-9 and FIM at years 1, 2, 5, and 10 post injury. RESULTS: A cross-lagged panel structural equation model, which is meant to indirectly infer causality through longitudinal correlational data, suggested that SI, depressive symptoms, and functional independence each significantly predicted themselves over time. Within the model, bivariate correlations among variables were all significant within each time point. Between years 1 and 2 and between years 2 and 5, depressive symptoms had a larger effect on SI than SI had on depressive symptoms. Between years 5 and 10, there was reciprocal causality between the 2 variables. Functional independence more strongly predicted depressive symptoms than the reverse between years 1 and 2 as well as years 2 and 5, but its unique effects on SI over time were extremely marginal or absent after controlling for depressive symptoms. CONCLUSIONS: A primary goal for rehabilitation and mental health providers should be to monitor and address elevated symptoms of depression as quickly as possible before they translate into SI, particularly for individuals with TBI who have reduced functional independence. Doing so may be a key to breaking the connection between low functional independence and SI.
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Lesões Encefálicas Traumáticas/psicologia , Lesões Encefálicas Traumáticas/reabilitação , Depressão/psicologia , Estado Funcional , Ideação Suicida , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To examine the utility of the sleep disturbance item of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for insomnia among individuals with moderate to severe traumatic brain injury (TBI). SETTING: Telephone interview. PARTICIPANTS: A sample of 248 individuals with a history of moderate to severe TBI participated in an interview within 2 years of their injury. DESIGN: Observational, cross-sectional analysis. MAIN MEASURES: The PHQ-9 was administered along with the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Sleep Hygiene Index, Epworth Sleepiness Scale, and the Insomnia Interview Schedule. RESULTS: Receiver operating characteristic curve analysis was conducted for the PHQ-9 sleep item rating against a set of insomnia criteria to determine an optimal cutoff score. A cutoff of 2 on the PHQ-9 sleep item maximized sensitivity (76%) and specificity (79%), with an area under the curve of 0.79 (95% CI, 0.70-0.88). The 2 groups formed using this cutoff differed significantly on all sleep measures except the Epworth Sleepiness Scale. CONCLUSIONS: The PHQ-9 sleep item may serve as a useful screener to allow for detection of potential sleep disturbance among individuals with moderate to severe TBI. Those who screen positive using this item included in a commonly used measure of depression can be prioritized for further and more comprehensive assessment of sleep disorders.
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Lesões Encefálicas Traumáticas , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Estudos Transversais , Humanos , Questionário de Saúde do Paciente , Sono , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/etiologia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Sonolência , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To describe the self-reported needs of family caregivers of service members and veterans (SMVs) who sustained a traumatic brain injury (TBI) and to identify predictors of the unmet family caregiver needs. SETTING: Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). PARTICIPANTS: Family caregivers of SMVs enrolled in the VA PRC TBI Model Systems (TBIMS) national database who were within their first 5 years post-TBI ( n = 427). DESIGN: Observational study. MAIN OUTCOME MEASURE: The Family Needs Questionnaire-Revised (FNQ-R) was completed by each SMV's designated caregiver. ANALYSES: Descriptive analyses were conducted on the FNQ-R responses at the item, domain, and total score levels. Unadjusted univariable and adjusted multivariable regression models were fitted to identify predictors of total unmet needs and unmet family need domains. RESULTS: FNQ-R item-level and domain-level descriptive results indicated that health information was the most frequently met need domain. In contrast, emotional and instrumental support domains were the least often met. On average, family caregivers reported that 59.2% of the 37 FNQ-R needs were met at the time of the follow-up assessment. Regression models indicated that both the number of SMV-perceived environmental barriers and whether the SMV received mental health treatment within the past year predicted the number of unmet FNQ-R needs. SMV-reported environmental barriers predicted increased unmet needs in all 6 family caregiver domains, and SMV mental health treatment in the past year predicted more unmet family caregiver emotional support, community support, and professional support needs. CONCLUSIONS: The current findings can be used to inform policy and programming for VA and Department of Defense to proactively address the specific needs of families and caregivers experienced in the first 5 years post-TBI.
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Lesões Encefálicas Traumáticas , Veteranos , Humanos , Lesões Encefálicas Traumáticas/reabilitação , Cuidadores/psicologia , Veteranos/psicologia , Inquéritos e Questionários , Centros de Reabilitação , Família/psicologiaRESUMO
OBJECTIVE: To identify group-based patterns in suicidal ideation (SI) over the first 10 years after traumatic brain injury (TBI). METHODS: Participants included 9539 individuals in the TBI Model Systems National Database who responded to Patient Health Questionnaire-9 Item 9 assessing SI at 1, 2, 5, and/or 10 years post-injury. A k-means cluster analysis was conducted to determine group-based patterns of SI, and pre-injury variables were compared with ANOVAs and chi-square tests. RESULTS: SI and attempts decreased over time. Four group-based patterns emerged: Low, increasing, moderate, and decreasing SI. The low SI group comprised 89% of the sample, had the highest pre-injury employment, fewer mental health vulnerabilities, least severe injuries, and were oldest. The increasing SI group had the most severe TBIs, were youngest, and disproportionately Black or Asian/Pacific Islander. CONCLUSION: These findings reinforce the importance of mental health and suicide risk assessment during chronic recovery from TBI.
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Lesões Encefálicas Traumáticas , Ideação Suicida , Lesões Encefálicas Traumáticas/psicologia , Emprego , Humanos , Saúde Mental , Fatores de RiscoRESUMO
OBJECTIVE: Describe who is able to return to driving (RTD) after moderate-to-severe traumatic brain injury (TBI), when this occurs, who maintains that activity, and the association with outcome. DESIGN: Cross-sectional descriptive study. SETTING: Eight follow-up sites of the TBI Model Systems (TBIMS) program. PARTICIPANTS: 618 participants enrolled in the TBIMS and 88 caregivers (N=706). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A survey was completed from 1-30 years postinjury focusing on RTD. Descriptors included demographic information, injury severity, and current employment status. Outcome was assessed at the time of the interview, including depression, quality of life, functional status, and community participation. RESULTS: Of 706 respondents, 78% (Nâ¯=â¯552) RTD, but 14% (Nâ¯=â¯77) of these did not maintain that activity. Of those who RTD, 43% (Nâ¯=â¯192) did so within 6 months of the injury and 92% did so within 24 months postinjury. The percentage of people driving after TBI did not differ significantly based on age at time of injury or follow-up. There were significant differences between drivers and nondrivers with respect to severity of injury, seizures, race, education, employment, rural vs urban setting, marital status, and family income. We performed a multivariate logistic regression to examine the association between driving status and demographic variables, adjusting for other variables in the model. The strongest associations were with current employment, family income, race, seizures, and severity of injury. Driving was associated with greater community participation, better functional outcomes, fewer symptoms of depression, and greater life satisfaction. CONCLUSIONS: Over a span of 30 years, three-quarters of people experiencing moderate-to-severe TBI return to driving a personal vehicle, although not everyone maintains this activity. Employment, race, family income, and seizures are strongly associated with RTD.
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Condução de Veículo , Lesões Encefálicas Traumáticas/reabilitação , Recuperação de Função Fisiológica , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índices de Gravidade do TraumaRESUMO
OBJECTIVE: Examine effects of age cohort on post-injury life satisfaction in elderly persons with TBIDesign: Retrospective cohortSetting: TBI Model Systems centers. PARTICIPANTS: 5,109 elderly participants with TBI in the TBI Model Systems National DatabaseInterventions: Not applicableMain Outcome Measures: Demographics, injury characteristics and cause, outcomes, age at time of analysis, time to follow commands, maximum follow-up period, and scores on the Satisfaction With Life Scale (SWLS) and Participation Assessment with Recombined Tools-Objective (PART-O) scores at 1, 2, 5, or 10 years post-injury. RESULTS: Life satisfaction post-TBI across groups increased with age. The young-old sub-group demonstrated the poorest life satisfaction outcomes, while the oldest sub-group experienced greatest life satisfaction. In contrast, participation decreased with age. CONCLUSIONS: Findings show diversity in satisfaction with life following moderate to severe TBI for three elderly age-cohorts. Differences may be due to variations in generation-based lived experience, in perceived meaningfulness of participation, could echo prior evidence of greater resilience in the oldest group, or could reflect bias within the study sample. Further research into between- and within- differences for elderly TBI age cohorts is needed to more precisely meet their needs for physical and functional rehabilitation as well as psychological supports.
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Lesões Encefálicas Traumáticas , Satisfação Pessoal , Idoso , Humanos , Estudos RetrospectivosRESUMO
OBJECTIVE: Describe driving patterns following moderate-to-severe traumatic brain injury (TBI). Participants: Adults (N = 438) with TBI that required inpatient acute rehabilitation who had resumed driving. DESIGN: Cross-sectional, observational design. SETTING: Eight TBI Model System sites. MAIN MEASURES: A driving survey was completed at phone follow-up. RESULTS: Most respondents reported driving daily, although 41% reported driving less than before their injury. Driving patterns were primarily associated with employment, family income, sex, residence, and time since injury, but not injury severity. Confidence in driving was high for most participants and was associated with a perception that the TBI had not diminished driving ability. Lower confidence and perceived loss of ability were associated with altered driving patterns. CONCLUSION: Most people with moderate-to-severe TBI resume driving but perhaps not at pre-injury or normal levels compared to healthy drivers. Some driving situations are restricted. The relationship between low confidence/perceived loss of ability and driving patterns/restrictions suggests people with TBI are exhibiting some degree of caution consistent with those perceptions. Careful assessment of driving skills and monitoring during early stages of RTD is warranted, particularly for younger, male, and/or single drivers who express higher levels of confidence.
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Condução de Veículo , Lesões Encefálicas Traumáticas , Lesões Encefálicas , Adulto , Lesões Encefálicas Traumáticas/epidemiologia , Estudos Transversais , Humanos , Masculino , PercepçãoRESUMO
Primary Objective: Survey TBI literature to identify evidence of risk for post-injury suicide.Literature Selection: Search terms ((traumatic brain injury OR TBI) AND (suicidality OR suicidal behaviour OR suicidal ideation)) entered in PubMed, OVID Medline, PsychInfo, and Web of Science for papers published in print 01/01/1997 to 06/30/2019.Analysis of Literature: Authors screened abstracts, excluding duplicates and articles not meeting inclusion/exclusion criteria. Full papers were reviewed to make final exclusions. Data were extracted from 40 papers included co- and premorbid disorders, demographics, injury-related and psychological factors.Results: Persons with TBI have a higher risk for suicide than the general population. Reviewed articles reported comorbid depression and/or PTSD as risk factors for post-TBI suicide. Co- or premorbid substance misuse, sex, and sleep disturbance moderate risk. Quality of the literature was limited by sample size, the predominance of male participants, and inconsistency in reporting of findings.Conclusions: Comorbid depression and PTSD are significant post-TBI risk factors for suicide. Several variables combine to moderate or mediate TBI's connection with suicide. Civilian and military clinician cross-talk and consistent reporting of results from reproducible studies of post-TBI suicide risk factors could improve prevention and treatment efforts in veterans and civilians.
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Lesões Encefálicas Traumáticas , Militares , Transtornos de Estresse Pós-Traumáticos , Suicídio , Veteranos , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/epidemiologia , Humanos , Masculino , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Ideação SuicidaRESUMO
OBJECTIVE: To investigate the feasibility and safety of robotic-assisted gait training (RAGT) in adults with disorders of consciousness (DoC). SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Four adult male patients with traumatic brain injury and DoC. DESIGN: Subjects participated in RAGT with body weight support for 5 to 20 minutes, over 1- to 2-week periods. MAIN MEASURES: Primary measures included vital signs, walking parameters, pain, arousal, and Agitation Behavior Scale scores. Additional data included Modified Ashworth Scale, Coma Recovery Scale-Revised, and Rancho Los Amigos Scale scores. RESULTS: All participants safely completed at least one session of RAGT with body weight support with safe vital signs and low agitation levels. Two adverse events occurred (increased somnolence and pain due to harness placement), which were not considered severe. All subjects emerged out of DoC at which point research protocol was stopped. CONCLUSIONS: Findings suggest inpatient-based RAGT may be safe and feasible to consider when developing a therapy plan of care in adults with DoC.
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Transtornos da Consciência/terapia , Terapia por Exercício , Transtornos Neurológicos da Marcha , Robótica , Adulto , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Transtornos da Consciência/complicações , Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , MasculinoRESUMO
OBJECTIVE: To determine the relationship between comorbid health conditions and the trajectory of functional recovery 5 years following traumatic brain injury (TBI) rehabilitation. SETTING: Two acute rehabilitation facilities. PARTICIPANTS: A total of 407 patients with primary diagnosis of TBI. DESIGN: Prospective, observational. MAIN MEASURES: Functional Independence Measure Cognitive and Motor scores. RESULTS: Female gender was negatively associated with the trajectory of motor recovery (P < .001). TBI severity was negatively associated with both motor and cognitive recovery and interacted with time after injury (both Ps < .0001). Hypertension was negatively associated with both motor (P < .0001) and cognitive (P = .0121) recovery, although this relationship diminished over time for motor function (P = .0447). Cardiac conditions were negatively associated with motor recovery (P = .0204), and rate of cognitive recovery was more rapid for patients with cardiac conditions (P = .0088). Depressed patients recovered cognitive function more quickly than those who were not depressed (P = .0196). Diabetes was negatively associated with motor function (P = .0088). Drug/alcohol use was positively associated with motor function (P = .0036). CONCLUSIONS: Injury severity remains an important predictor of long-term recovery; however, certain comorbid medical conditions are negatively associated with functional abilities over the first 5 years after injury. Patients being discharged from TBI rehabilitation with comorbid cardiac, hypertensive, diabetic, and/or depressive conditions may benefit from early and ongoing clinical surveillance.
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Lesões Encefálicas Traumáticas , Comorbidade , Alcoolismo/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/reabilitação , Cognição , Depressão/complicações , Feminino , Cardiopatias/complicações , Humanos , Masculino , Estudos Prospectivos , Recuperação de Função Fisiológica , Centros de Reabilitação , Transtornos Relacionados ao Uso de Substâncias/classificaçãoRESUMO
OBJECTIVE: Investigate effectiveness of a 5-session manualized intervention for addressing needs of caregivers of persons in acute traumatic brain injury (TBI) rehabilitation. DESIGN: Prospective, pilot randomized controlled trial. SETTING: Inpatient brain injury rehabilitation unit, level 1 trauma center. PARTICIPANTS: Patients (N=93) with moderate-to-severe TBI and their family members were enrolled in the study with 42 randomized to the treatment group, 51 to the control group. INTERVENTION: Five-session manualized caregiver intervention with educational, stress and anxiety self-management, coping, and emotional support components. MAIN OUTCOME MEASURES: Family Needs Questionnaire-Revised, knowledge assessment, Zarit Family Burden Scale, and Brief Symptom Inventory-18 were collected at pretreatment, posttreatment, and 3-month follow-up. RESULTS: Treatment group caregivers showed an increase in met needs for emotional, instrumental, and professional support, and brain injury knowledge from baseline to posttreatment, whereas controls did not. Between-group differences were significant for only emotional support needs. Treatment effects were not sustained at 3-month follow-up. CONCLUSIONS: Caregivers of persons undergoing acute TBI rehabilitation may benefit from interventions that target their unique needs. Caregivers may require additional and longer-term supports to sustain treatment benefits.
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Lesões Encefálicas Traumáticas/reabilitação , Lesões Encefálicas/reabilitação , Cuidadores/educação , Autogestão/educação , Adaptação Psicológica , Adulto , Ansiedade/psicologia , Lesões Encefálicas/psicologia , Lesões Encefálicas Traumáticas/psicologia , Cuidadores/psicologia , Emoções , Família/psicologia , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Autogestão/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To characterize employment stability and identify predictive factors of employment stability in working-age individuals after moderate-to-severe traumatic brain injury (TBI) that may be clinically addressed. DESIGN: Longitudinal observational study of an inception cohort from the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) using data at years 1, 2, and 5 post-TBI. SETTING: Inpatient rehabilitation centers with telephone follow-up. PARTICIPANTS: Individuals enrolled in the TBIMS-NDB since 2001, aged 18-59, with employment data at 2 or more follow-up interviews at years 1, 2, and 5 (N=5683). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Employment stability, categorized using post-TBI employment data as no paid employment (53.25%), stably (27.20%), delayed (10.24%), or unstably (9.31%) employed. RESULTS: Multinomial regression analyses identified predictive factors of employment stability, including younger age, white race, less severe injuries, preinjury employment, higher annual earnings, male sex, higher education, transportation independence postinjury, and no anxiety or depression at 1 year post-TBI. CONCLUSIONS: Employment stability serves as an important measure of productivity post-TBI. Psychosocial, clinical, environmental, and demographic factors predict employment stability post-TBI. Notable predictors include transportation independence as well as the presence of anxiety and depression at year 1 post-TBI as potentially modifiable intervention targets.
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Lesões Encefálicas Traumáticas/reabilitação , Emprego/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Centros de Reabilitação , Fatores de Tempo , Adulto JovemRESUMO
Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served.
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Difusão de Inovações , Registros Eletrônicos de Saúde/estatística & dados numéricos , Disseminação de Informação , Qualidade da Assistência à Saúde/organização & administração , Pesquisa de Reabilitação/organização & administração , Comunicação , Eficiência Organizacional , Humanos , Segurança do Paciente , Assistência Centrada no Paciente/organização & administração , Políticas , Qualidade da Assistência à Saúde/normas , Gestão da Segurança/organização & administração , Fatores de TempoRESUMO
OBJECTIVE: To examine the needs of family members in an inpatient setting and factors predicting extent to which needs are perceived as met. SETTING: University health system inpatient rehabilitation unit. PARTICIPANTS: Adult survivors of traumatic brain injury and family members (n = 85). DESIGN: Prospective, cross-sectional. MAIN MEASURE: Family Needs Questionnaire-Revised (FNQ-R). RESULTS: Needs related to the Health Information subscale were most frequently rated as met, whereas needs related to the Instrumental Support and Emotional Support subscales were most frequently rated as unmet. Predictors related to the FNQ-R included family income, gender, and ethnicity. For 4 of 6 subscales, white family members were more likely to rate needs as unmet than minority members. For 3 subscales, females were more likely to rate needs as unmet than males. Greater household income was associated with fewer met needs for 2 subscales. CONCLUSIONS: The ranking of met and unmet needs in the present study was remarkably similar to previous studies within and outside the United States. Clinicians should not assume that families with relatively higher incomes will experience fewer unmet needs. Through structured assessment, clinicians can reveal perceived needs that might have otherwise been unrecognized and facilitate appropriate supports. Findings provide direction for inpatient program development.
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Lesões Encefálicas Traumáticas/reabilitação , Família/psicologia , Centros de Reabilitação/organização & administração , Inquéritos e Questionários , Adulto , Idoso , Análise de Variância , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/psicologia , Cuidadores/psicologia , Estudos Transversais , Estudos de Avaliação como Assunto , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Estudos Prospectivos , Sobreviventes/psicologia , Estados UnidosRESUMO
OBJECTIVE: To determine whether severity of head and extracranial injuries (ECI) is associated with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI). DESIGN: Factors associated with SI and SA were assessed in this inception cohort study using data collected 1, 2, and 5 years post-TBI from the National Trauma Data Bank and Traumatic Brain Injury Model Systems (TBIMS) databases. SETTING: Level I trauma centers, inpatient rehabilitation centers, and the community. PARTICIPANTS: Participants with TBI from 15 TBIMS Centers with linked National Trauma Data Bank trauma data (N=3575). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: SI was measured via the Patient Health Questionnaire 9 (question 9). SA in the last year was assessed via interview. ECI was measured by the Injury Severity Scale (nonhead) and categorized as none, mild, moderate, or severe. RESULTS: There were 293 (8.2%) participants who had SI without SA and 109 (3.0%) who had SA at least once in the first 5 years postinjury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe (odds ratio=2.73; 95% confidence interval, 1.55-4.82; P=.001). Drug use at time of injury was also associated with SI (odds ratio=1.69; 95% confidence interval, 1.11-2.86; P=.015). Severity of ECI was not associated with SA. CONCLUSIONS: Severe ECI carried a nearly 3-fold increase in the odds of SI after TBI, but it was not related to SA. Head injury severity and less severe ECI were not associated with SI or SA. These findings warrant additional work to identify factors associated with severe ECI that make individuals more susceptible to SI after TBI.
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Lesões Encefálicas Traumáticas/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adulto , Fatores Etários , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/reabilitação , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Raciais , Fatores Sexuais , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Fatores de Tempo , Índices de Gravidade do TraumaRESUMO
OBJECTIVE: To describe the extent to which adherence to Consolidated Standards of Reporting Trials (CONSORT) statement in randomized controlled trials (RCTs) in adult traumatic brain injury (TBI) has improved over time. DATA SOURCES: MEDLINE, PsycINFO, and CINAHL databases were searched from inception to September 2013. STUDY SELECTION: Primary report of RCTs in adult TBI. The quality of reporting on CONSORT checklist items was examined and compared over time. Study selection was conducted by 2 researchers independently. Any disagreements were solved by discussion. DATA EXTRACTION: Two reviewers independently conducted data extraction based on a set of structured data extraction forms. Data regarding the publication years, size, locations, participation centers, intervention types, intervention groups, and CONSORT checklist items were extracted from the including trials. DATA SYNTHESIS: Of 105 trials reviewed, 38.1%, 5.7%, and 32.4% investigated drugs, surgical procedures, and rehabilitations as the intervention of interest, respectively. Among reports published between the 2 periods 2002 and 2010 (n=51) and 2011 and September 2013 (n=16), the median sample sizes were 99 and 118; 39.2% and 37.5% of all reports detailed implementation of the randomization process; 60.8% and 43.8% provided information on the method of allocation concealment; 56.9% and 31.3% stated how blinding was achieved; 15.7% and 43.8% reported information regarding trial registration; and only 2.0% and 6.3% stated where the full trial protocol could be accessed, all respectively. CONCLUSIONS: Reporting of several important methodological aspects of RCTs conducted in adult TBI populations improved over the years; however, the quality of reporting remains below an acceptable level. The small sample sizes suggest that many RCTs are likely underpowered. Further improvement is recommended in designing and reporting RCTs.
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Lesões Encefálicas/terapia , Documentação/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Editoração/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Humanos , Revisão da Pesquisa por Pares/normas , Projetos de PesquisaRESUMO
OBJECTIVE: To examine the comparative efficacy of 3 common measures of traumatic brain injury (TBI) severity for predicting inpatient outcomes upon hospital discharge. SETTING: Acute brain injury rehabilitation unit at level 1 trauma center. PARTICIPANTS: 100 patients with TBI. DESIGN: Retrospective analysis of injury severity, demographic, and outcome data. MAIN MEASURES: Glasgow Coma Scale (GCS) at admission, time to follow commands (TTC), duration of posttraumatic amnesia (PTA), and Functional Independence Measure at hospital discharge. RESULTS: A hierarchal multiple regression revealed that duration of PTA was a significant and powerful unique predictor of Functional Independence Measure scores at discharge (ß = -0.46, P = .001), while TTC (ß = 0.26, P = .056) and GCS (ß = 0.16, P = .143) were not. These effects were present even after controlling for age, gender, educational level, racial/ethnic minority status, cause of injury, history of substance abuse, and neurosurgical intervention. CONCLUSION: Although clinicians often use GCS scores and TTC when assessing acute TBI severity and during treatment formulation, this study provides evidence that duration of PTA may be a more meaningful predictor of patients' functional levels at discharge.
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Lesões Encefálicas/reabilitação , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas/psicologia , Feminino , Escala de Coma de Glasgow , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Adulto JovemRESUMO
The scientific traumatic brain injury (TBI) literature chronicles 50 years of epidemiologic data, neurobehavioral and cognitive symptoms, diagnostic tools for measuring outcomes, and treatments for persons with TBI. In this article, we review the state of our knowledge about TBI causes and symptom complexities, evidence-based treatments, and ongoing treatment needs.
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Lesões Encefálicas/etiologia , Lesões Encefálicas/terapia , Lesões Encefálicas/psicologia , HumanosRESUMO
In the United States, 1.7 million people sustain a traumatic brain injury (TBI) each year, of whom 52,000 die and 275,000 are hospitalized. Societal costs of TBI total at least $10 billion. In this article, we review the current state of treatment and policy and make recommendations that would benefit TBI survivors with behavioral health comorbidities.