Six of one, half a dozen of the other? Examining measurement properties of different potentially traumatic event polyvictimization operationalizations using a multiverse analysis framework.

Numerous differences exist between and within research projects related to assessment and operationalization of potentially traumatic events (PTEs) for youth, especially when measuring polyvictimization. However, few studies have systematically examined how polyvictimization measurement differences influence PTE's relation to functioning. This study sought to address these knowledge gaps by conducting a secondary data multiverse replication (SDMR) to systematically (re)evaluate PTE polyvictimization measurement approaches. Participants included 3297 adolescents (Mage = 14.63; 50.59% female; 65.15% white) from the National Survey of Adolescents-Replication study who completed a structured interview on PTE exposure and emotional and behavioral health (i.e., posttraumatic stress and major depressive disorder, drug and alcohol use, and delinquency). Results indicated that PTE operationalizations using a count variable tended to demonstrate better model performance and prediction of youth at-risk of emotional and behavioral health challenges, compared to models using a binary (yes/no) PTE operationalization. Differences in model performance and prediction were less distinct between models examining multiple forms of a single type of PTE (e.g., maltreatment, community violence), compared to models examining multiple PTE types. These findings emphasize the importance of using multidimensional approaches to PTE operationalization and the need for more multiverse analyses to improve PTE evidence-based assessment.

Relationship between loneliness and post-traumatic growth in patients with gynecologic malignancies: the mediating role of self-disclosure and psychological resilience.

BACKGROUND: To explore the relationship between loneliness and post-traumatic growth, with a focus on the mediating role of psychological resilience and self-disclosure. METHODS: This study was a cross-sectional survey using the Loneliness Scale for Cancer Patients, the Distress Expression Index Scale (for measuring self-disclosure), the Psychological Resilience Scale, and the Posttraumatic Growth Scale on 215 inpatients with gynecologic malignancies at a tertiary care hospital in Guangzhou. Subsequently, Correlation, regression, and mediation analyses were performed using SPSS to test the relationships between the variables. RESULTS: The results showed that loneliness was negatively correlated with posttraumatic growth (r = -0.261, P < 0.001), self-disclosure was positively correlated with posttraumatic growth (r = 0.360, P < 0.001), and psychological resilience was positively correlated with posttraumatic growth (r = 0.475, P < 0.001); loneliness was correlated with self-disclosure (r = -0.194, P < 0.01), loneliness was negatively correlated with psychological resilience (r = -0.287, P < 0.001), self-disclosure was correlated with psychological resilience (r = 0.287, P < 0.001); loneliness was significantly correlated with self-disclosure (r = -0.314, P < 0.001); loneliness was not a direct predictor of posttraumatic growth (ß = -0.108, t = 1.734, P > 0.05), but could influence posttraumatic growth through the mediated effect of self-disclosure and psychological resilience, where the total indirect effect of self-disclosure and psychological resilience was - 0.155 (95% CI: -0.236, -0.081, P < 0.001). CONCLUSIONS: The mechanism of loneliness on post-traumatic growth in patients with gynecologic malignancies is mainly through the indirect effect of self-disclosure and the indirect impact of psychological resilience. Great attention should be paid to patients' loneliness, to find factors promoting patients' self-disclosure, to improve the level of patients' psychological resilience, and promote post-traumatic growth of gynecologic malignant tumors.

A Narrative Review of Post-traumatic Neuroinflammation: Relevance to Pediatrics.

This is a narrative review that explores the complex interaction between post-traumatic neuroinflammation and its importance in pediatric traumatic brain injuries (TBIs). For immediate and long-term consequences of TBI, neuroinflammation, manifested by activation of microglia and astrocytes, secretion of pro-inflammatory cytokines, as well as breakdown of the blood-brain barrier, are critical factors. While inflammation is an essential part of the brain's repair systems, excessive or prolonged neuroinflammation can lead to more significant neuronal damage, which, in turn, causes persistent cognitive and behavioral deficits over time. In this regard, the paper synthesizes existing evidence concerning molecular and cellular mechanisms that underlie neuroinflammation in relation to TBI among children, paying attention to age disparities in inflammatory response and their implications for treatment and recovery. Furthermore, it explores how targeted anti-inflammatory therapies are highly likely to improve outcomes for pediatric patients. The outcomes emphasize that there is a need for a more comprehensive understanding of child neuroinflammatory processes and age-specific therapeutic approaches aimed at lessening the effects' negative impacts after brain injury occurs.

Epidemiological characteristics of post-traumatic stress symptoms and its influence on length of hospital stay in inpatients with traumatic fractures in Zunyi, China.

Objectives: To investigate the clinical epidemiological characteristics and occurrence of post-traumatic stress symptoms (PTSS) in patients with traumatic fractures, we sought to analyze the factors that influence the prognosis of a length of hospital stay (LOS) and provide valuable insights to prevent PTSS in fracture patients and improve their prognosis. Methods: Inpatients with traumatic fractures were recruited from a third-class comprehensive general hospital in southwest China between November 2019 and October 2020. Case data of traumatic fracture patients were collected, and a questionnaire that included general information and basic fracture details was completed. The post-traumatic stress disorder Self-rating Scale was used to assess PTSS among the fracture inpatients. Results: A total of 204 inpatients who experienced traumatic fractures were included in this study. Falls accounted for the largest proportion of traumatic fractures. A Cox's regression analysis revealed that serious injury [Hazard Ratio (HR) = 2.44, 95% Confidence Interval (CI): 1.33-4.46], critical illness during hospitalization (HR = 1.70, 95% CI: 1.13-2.54), and undergoing two surgeries (HR = 1.87, 95% CI: 1.20-2.93) were risk factors for longer LOS. Among the fracture patients, 30.39% exhibited positive PTSD symptoms, and physical activity during the fracture [Odds Ratio (OR) = 0.63, 95% CI: 0.45-0.88] and increased pain (OR = 3.34, 95% CI: 1.82-6.11) were identified as influencing factors. Conclusions: Given the high detection rate of PTSS following traumatic fractures, it is crucial for relevant departments to implement targeted measures to protect high risk individuals. Furthermore, strengthening the care provided to the patients' physical and mental health is urgently needed to reduce the incidence of PTSS.

Role of Ultrasonography in the Evaluation of Peripheral Nerve Pathologies: A Study of 200 Cases.

AIM: The aim of this study is to ascertain the role of ultrasonography in appraising the structural intricacies of peripheral nerve pathologies. OBJECTIVES: (1) To scrutinize the anatomy of both normal and abnormal peripheral nerves. (2) Assess different parameters like continuity of the nerve, echotexture, vascularity, cross-sectional area, and thickness of the nerve in various pathologies. METHODS AND MATERIALS: In a prospective observational study conducted at the Department of Radio Diagnosis, Tertiary Care Centre, the study design focused on the examination of 200 cases utilizing a high-resolution 9-14 Mhz and 17 Mhz linear array transducer, integrated into the Aplio 400 Canon Ultrasound System. RESULTS: Among the total cases, 62 were identified as traumatic neuropathy cases, 52 as entrapment neuropathy cases, 14 as infective neuropathy cases, 54 as thermal neuropathy cases, 14 as metabolic neuropathy cases, and 4 as nerve-tumor cases. CONCLUSIONS: In conclusion, this investigation illuminates the dynamic role of ultrasonography as an invaluable diagnostic instrument in appraising peripheral nerve pathologies. The noninvasive attributes, widespread availability, and economic viability of ultrasonography render it a pragmatic choice for clinicians. This inquiry buttresses the escalating significance of ultrasonography within neurology, emphasizing its potential to revolutionize the terrain of peripheral nerve pathology assessment.

The effects of trauma-focused treatment on painful temporomandibular disorders, awake bruxism and sleep bruxism in patients with severe post-traumatic stress disorder.

BACKGROUND: Chronic painful temporomandibular disorders (TMD), awake bruxism and sleep bruxism are often comorbid with post-traumatic stress disorder (PTSD), but the implications for treatment are unknown. OBJECTIVE(S): To explore the effects of PTSD treatment on these conditions. We hypothesized that chronic painful TMD, pain intensity, pain interference, awake bruxism and sleep bruxism would decrease after evidence-based trauma-focused treatment and that this decrease would be maintained at the 6-month follow-up. METHODS: Individuals referred for PTSD treatment were assessed for chronic painful TMD (temporomandibular disorder pain screener), pain intensity, pain interference (Graded Chronic Pain Scale 2.0), awake bruxism and sleep bruxism (oral behaviours checklist) pre-, post-treatment and at the 6-month follow-up. Hypotheses were tested using the Friedman test, followed by a post hoc Wilcoxon signed-rank test. Effect sizes (Cohen's r) are reported. Barely any pain interference was reported, therefore these outcomes were not analysed. RESULTS: In individuals with chronic painful TMD (n = 98), pain intensity, awake bruxism and sleep bruxism decreased across the three time points. Post hoc tests showed that chronic painful TMD (r = 0.59), pain intensity (r = 0.28), awake bruxism (r = 0.51) and sleep bruxism (r = 0.35) decreased between pre- and post-treatment. Between pre-treatment and the 6-month follow-up, chronic painful TMD (r = 0.58), awake bruxism (r = 0.30) and sleep bruxism (r = 0.39) decreased as well. CONCLUSION: The results provide preliminary support for a trauma-sensitive approach for patients with chronic painful TMD and PTSD and suggest that trauma-focused treatment may be beneficial for chronic painful TMD, awake bruxism and sleep bruxism in patients with PTSD and chronic painful TMD.

External evaluation of Brain Injury Guideline (BIG) low risk criteria for traumatic brain injury.

BACKGROUND: Fewer than 20 % of traumatic brain injury (TBI) cases with traumatic intracranial hemorrhage (ICH) result in clinical deterioration. The Brain Injury Guideline (BIG) criteria were published in 2014 and categorize patients with TBI into three risk groups (BIG 1, 2, and 3) based on CT scan findings, neurological examination, anti-coagulant/platelet medications, and intoxication. Early data is promising, suggesting no instances of neurosurgical intervention or death in the low-risk BIG1 category within 30 days. We sought to externally validate the BIG criteria and identify patients with TBI at low risk of clinical deterioration. We hypothesized that patients meeting the BIG1 low risk criteria have less than a 1 % risk of death or neurosurgical intervention. METHODS: We performed a retrospective cohort study of a level 1 trauma center's trauma registry records from 2011 to 2022 to identify patients with head trauma. We abstracted demographics, injury characteristics, clinical course, CT imaging results, and outcomes, and we categorized patients according to the BIG criteria. The Clopper-Pearson Exact method was used to estimate outcome frequency with confidence intervals. The primary outcome was death or neurosurgical intervention within 30 days. Secondary outcomes included progression on repeat head CT (RHCT), ICU admission with neurocritical care intervention, and TBI-related hospital readmission within 30 days. RESULTS: A total of 1714 patients with TBI with ICH were identified from the trauma registry. 325 patients were excluded due to missing data, pregnancy, incarceration, polytrauma, or GCS < 13, leaving 1389 for analysis. 193 patients (13.9 %) were classified as BIG1. No patients classified as BIG1 experienced the primary outcome measures of death or neurosurgical intervention (95 % confidence interval [CI]: 0 %-1.9 %). The number of patients who experienced the secondary outcome measures of progression on RHCT, ICU admission with neurocritical care intervention, or TBI-related hospital readmission within 30 days were 9 (4.7 %, 95 % CI: 2.2 %-8.7 %), 1 (0.5 %, 95 % CI: 0 %-2.9 %), and 4 (2.1 %, 95 % CI: 0.6 %-5.2 %), respectively. CONCLUSION: BIG1 criteria identified a low-risk subset of patients with TBI with ICH. However, an upper 95 % CI of 1.9 % does not exclude the risk of neurologic deterioration being <1 %. Validation of these criteria in larger cohorts is warranted.

The role of mind-body interventions in traumatised refugees' primary care: A qualitative exploration of professionals' experiences in a dedicated programme in Geneva.

Post-traumatic physical and psychological symptoms are pervasive among refugees. Primary care staff face numerous challenges and often seek innovative ways of addressing their refugee patients' physical and mental health needs. A nascent body of literature suggests that mind-body interventions (MBIs1) have a positive effect on post-traumatic symptoms in this population. But the quality of evidence is still poor, and little is known about the role MBI could play in the primary care of refugees. Following the implementation of two different kinds of MBI in a dedicated primary care unit, this study aimed to explore staff members' perceptions and prescribing habits for MBI. Given the paucity of information about this topic, we used a qualitative design combining ethnography and discourse analysis providing in-depth insight into professionals' experiences of MBI. Data collected over five-months of non-participative observation and the transcription of twelve interviews were analysed following the Interpretative Phenomenological Analysis method (IPA) yielding four main results: (1) Generally poor initial understanding of MBI; (2) A variety of conditions and situations where MBIs appeared acceptable and helpful; (3) A persistent lack of experience and knowledge about the indications for MBI, hindering prescription; (4) The importance of articulating MBIs with mental health services. These results, in the light of the existing literature, suggest that stronger evidence for MBI efficacy for refugees is required, a key to improving professionals' understanding of MBI, providing them with explicit prescription criteria, and encouraging stakeholders to implement these innovative interventions.

Targeting ferroptosis in treating traumatic brain injury: Harnessing the power of traditional Chinese medicine.

Traumatic brain injury (TBI) exhibits high prevalence and mortality, but current treatments remain suboptimal. Traditional Chinese medicine (TCM) has long been effectively used for TBI intervention. Moreover, the recently discovered iron-dependent cell death pathway, known as ferroptosis, characterized by lipid peroxidation, as a key target in TCM-based treatments for TBI. This review provides a comprehensive overview of the latest advancements in TCM strategies targeting ferroptosis in TBI therapy, covering natural product monomers, classic formulas, and acupuncture/moxibustion. The review also addresses current challenges and outlines future research directions to further advance the development and application of TBI management strategies.

Acquired ectopic nail: A case report in an 18-year-old female with traumatic onset.

INTRODUCTION AND IMPORTANCE: Post-traumatic ectopic nail (PTEN) refers to the abnormal growth of a new nail in a site other than the usual one, typically occurs after a trauma to the nail matrix. The exact pathogenesis is still unknown. This rare condition often affects the dorsal aspect of the phalanx. Surgical excision of the nail is the treatment of choice, with complete destruction of the nail matrix. PRESENTATION OF CASE: We report a case of an 18-year-old female presenting to the clinic with an asymptomatic keratotic lesion on the lateral aspect of the distal phalanx after 3 years of digit trauma. X-ray imaging of the affected finger was normal, without any bony deformity. The ectopic nail was surgically excised with cauterization of the matrix to prevent relapse. CLINICAL DISCUSSION: Ectopic nails can be either congenital or acquired. Injuries can lead to PTEN formation by causing the germinal matrix to divide and implant into the skin. The ectopic nail in our case arises from the lateral aspect of the finger 3 years after trauma, which is an unusual occurrence. CONCLUSION: The ectopic nail causes an aesthetical concern, usually with no other symptoms. However, surgical excision is necessary, with emphasis on the importance of cauterizing the matrix to prevent future relapse.

Traumatic Aortic Disruption Index (TADI) is associated with mortality and urgency of stent grafting in blunt thoracic aortic (Grade 3) injuries.

OBJECTIVE: Delayed stent grafting for blunt thoracic aortic injuries (BTAI) is current standard of care. However, given the heterogeneity of pseudoaneurysm presentations, it is currently unclear which severe BTAIs require more urgent intervention. We hypothesize that a Traumatic Aortic Disruption Index (TADI) calculation based on sagittal computed tomography angiography (CTA) imaging measurements would correlate with urgency of stent grafting. METHODS: All patients at a level-1 trauma center with BTAIs over a 12-year period were identified. A TADI score was then calculated using the length of pseudoaneurysm (L), maximum width of pseudoaneurysm (W), and normal adjacent aortic diameter (NA) (Figure1). Patient presentation, injury characteristics, timing of stent grafting, and outcomes were then evaluated. RESULTS: Forty-two patients were diagnosed with BTAIs. Mean age was 37.6 years, with a median injury severity score (ISS) of 29. Overall mortality was 11.9%. TADI scores ranged from 3.6 to 158.6. Compared to patients with a TADI<28, patients with TADI>28 had similar median ISS scores (34 vs 29, p=0.16), and rates of both traumatic brain injury (33.3% vs 42.0%, p=0.53) and non-aortic hemorrhage control procedures (44.4% vs 33.3%, p=0.3). TADI>28 patients had a lower initial mean systolic BP (98.5 vs 121.9, p=.003), more severe hypotension (lowest systolic 77.0 vs 91.2, p=.034), lower initial GCS (6 vs 13, p=.039), higher mean admission lactate (4.6 vs 3.3, p=.036), and higher overall mortality (23.8% vs 0%, p=.048). Patients with TADI>28 received stent grafting at significantly shorter median time intervals from injury identification (median 4 hrs vs 14 hrs, p=.001). Overall causes of mortality were aortic hemorrhage related (n=3, 60%) and traumatic brain injury (n=2, 40%). CONCLUSION: This simple-to-calculate index is independently correlated with mortality and urgency of stent grafting in blunt trauma patients with similar ISS. Patients with TADI scores >28 were more likely to undergo urgent stent grafting, thereby suggesting a trend in practice patterns with higher scores representing injuries that should be considered for expedited operative management. The TADI score should be validated in a larger sample of blunt trauma patients as an injury prioritization tool in the multi-system injured patient.

Association of concussion history with psychiatric symptoms, limbic system structure, and kynurenine pathway metabolites in healthy, collegiate-aged athletes.

Psychiatric outcomes are commonly observed in individuals with repeated concussions, though their underlying mechanism is unknown. One potential mechanism linking concussion with psychiatric symptoms is inflammation-induced activation of the kynurenine pathway, which is thought to play a role in the pathogenesis of mood disorders. Here, we investigated the association of prior concussion with multiple psychiatric-related outcomes in otherwise healthy male and female collegiate-aged athletes (N = 212) with varying histories of concussion recruited from the community. Specially, we tested the hypotheses that concussion history is associated with worse psychiatric symptoms, limbic system structural abnormalities (hippocampal volume, white matter microstructure assessed using neurite orientation dispersion and density imaging; NODDI), and elevations in kynurenine pathway (KP) metabolites (e.g., Quinolinic acid; QuinA). Given known sex-effects on concussion risk and recovery, psychiatric outcomes, and the kynurenine pathway, the moderating effect of sex was considered for all analyses. More concussions were associated with greater depression, anxiety, and anhedonia symptoms in female athletes (ps ≤ 0.005) and greater depression symptoms in male athletes (p = 0.011). More concussions were associated with smaller bilateral hippocampal tail (ps < 0.010) and left hippocampal body (p < 0.001) volumes across male and female athletes. Prior concussion was also associated with elevations in the orientation dispersion index (ODI) and lower intracellular volume fraction in several white matter tracts including the in uncinate fasciculus, cingulum-gyrus, and forceps major and minor, with evidence of female-specific associations in select regions. Regarding serum KP metabolites, more concussions were associated with elevated QuinA in females and lower tryptophan in males (ps ≤ 0.010). Finally, serum levels of QuinA were associated with elevated ODI (male and female athletes) and worse anxiety symptoms (females only), while higher ODI in female athletes and smaller hippocampal volumes in male athletes were associated with more severe anxiety and depression symptoms (ps ≤ 0.05). These data suggest that cumulative concussion is associated with psychiatric symptoms and limbic system structure in healthy athletes, with increased susceptibility to these effects in female athletes. Moreover, the associations of outcomes with serum KP metabolites highlight the KP as one potential molecular pathway underlying these observations.

Copper aggravated synaptic damage after traumatic brain injury by downregulating BNIP3-mediated mitophagy.

Synaptic damage is a crucial pathological process in traumatic brain injury. However, the mechanisms driving this process remain poorly understood. In this report, we demonstrate that the accumulation of damaged mitochondria, resulting from impaired mitphagy, plays a significant role in causing synaptic damage. Moreover, copper induced downregulation of BNIP3 is a key player in regulating mitophagy. DMSA alleviates synaptic damage and mitochondrial dysfunction by promoting urinary excretion of copper. Mechanistically, we find that copper downregulate BNIP3 by increasing the nuclear translocation of NFKB, which is triggered by TRIM25-mediated ubiquitination-dependent degradation of NFKBIA. Our study underscores the importance of copper accumulation in the regulation of BNIP3-mediated mitophagy and suggests that therapeutic targeting of the copper-TRIM25-NFKB-BNIP3 axis holds promise to attenuate synaptic damage after traumatic brain injury.

Evaluation of validity and reliability of AI Chatbots as public sources of information on dental trauma.

AIM: This study aimed to assess the validity and reliability of AI chatbots, including Bing, ChatGPT 3.5, Google Gemini, and Claude AI, in addressing frequently asked questions (FAQs) related to dental trauma. METHODOLOGY: A set of 30 FAQs was initially formulated by collecting responses from four AI chatbots. A panel comprising expert endodontists and maxillofacial surgeons then refined these to a final selection of 20 questions. Each question was entered into each chatbot three times, generating a total of 240 responses. These responses were evaluated using the Global Quality Score (GQS) on a 5-point Likert scale (5: strongly agree; 4: agree; 3: neutral; 2: disagree; 1: strongly disagree). Any disagreements in scoring were resolved through evidence-based discussions. The validity of the responses was determined by categorizing them as valid or invalid based on two thresholds: a low threshold (scores of ≥ 4 for all three responses) and a high threshold (scores of 5 for all three responses). A chi-squared test was used to compare the validity of the responses between the chatbots. Cronbach's alpha was calculated to assess the reliability by evaluating the consistency of repeated responses from each chatbot. CONCLUSION: The results indicate that the Claude AI chatbot demonstrated superior validity and reliability compared to ChatGPT and Google Gemini, whereas Bing was found to be less reliable. These findings underscore the need for authorities to establish strict guidelines to ensure the accuracy of medical information provided by AI chatbots.

EEG Oscillatory Activity and Resting-State Networks Associated with Neurocognitive Function in Mild Traumatic Brain Injury.

This study aimed to investigate the characteristics of resting-state electroencephalography (EEG) activity and brain networks in patients with mild traumatic brain injury (mTBI) and their association with neurocognitive function (NCF). We analyzed 26 patients with subacute mTBI and 21 healthy controls. The subacute mTBI group (9 females, 17 males) had a mean age of 29.9 ± 9.9 years, and the healthy controls (11 females, 10 males) had a mean age of 29.7 ± 11.5 years. Current source density, lagged phase synchronization, and resting-state network activity were analyzed using exact low-resolution electromagnetic tomography (eLORETA) with 60 s resting-state EEG data. In addition, a correlation analysis was performed between these EEG parameters and NCF in patients with mTBI. We used the statistical nonparametric mapping method in eLORETA to correct for multiple comparisons. There were no significant differences in EEG parameters between the patients with mTBI and healthy controls. However, in patients with mTBI, correlation analysis revealed negative correlations between theta activity in the anterior cingulate cortex and verbal short-term memory and between activity in the memory perception network and verbal memory. Our findings suggest that resting-state EEG may be clinically useful in investigating the mechanism of NCF decline in patients with mTBI.

[Growing skull fracture of the orbital roof: case report and literature review]. / Rastushchii perelom verkhnei stenki orbity. Klinicheskii sluchai i obzor literatury.

BACKGROUND: Growing skull fracture (GSF) of the orbital roof is a rare complication of head injury in infancy and early childhood. Analysis of the Medline database between 1983 and 2023 identified 17 articles describing 63 children after surgical treatment of GSF of the orbital roof. MATERIAL AND METHODS: We present a 2-year-old child with moderate traumatic brain injury (TBI) complicated by GSF of the orbital roof. Neuroimaging and literature data are described. RESULTS: Severe ophthalmological symptoms in acute period of TBI subsequently partially regressed with persistent swelling of the upper eyelid and hypophthalmos. CT and MRI revealed a linear fracture of the frontal bone extending to superior orbital wall and intraorbital collection of cerebrospinal fluid (pseudomeningocele) mixed with blood. MR signs of GSF of the orbital roof with pseudomeningocele shrinkage were found in 5 weeks after injury. After 6 months, CT and MRI revealed signs of more severe GSF. Surgical treatment implied craniotomy, excision of scars, arachnoid membrane and abnormal brain matter, resection of deformed fracture edges, dura mater sealing and orbital roof reconstruction with bone autograft. Ophthalmological symptoms regressed after 6 months. The follow-up period was 6 years. There were no signs of fracture recurrence. CONCLUSION: In this case, acute intraorbital pseudomeningocele led to GSF of the orbital roof in 5 weeks after injury. Incomplete regression of ophthalmological symptoms, their aggravation or delayed appearance in children with orbital roof fracture requires a thorough examination including high-resolution CT and MRI, and orbital roof GSF should be considered in the differential diagnosis.

Chronic headaches after traumatic brain injury: Diagnostic complexity associated with increased cost.

BACKGROUND: Chronic headache after traumatic brain injury (TBI) is a common, yet disabling, disorder whose diverse clinical characteristics and treatment needs remain poorly defined. OBJECTIVE: To examine diagnostic coding patterns and cost among military Veterans with comorbid chronic headache and TBI. METHODS: We identified 141,125 post-9/11 era Veterans who served between 2001 and 2019 with a headache disorder diagnosed after TBI. We first identified patterns of Complex Headache Combinations (CHC) and then compared the patterns of healthcare costs in 2022-dollar values in the three years following the TBI diagnosis. RESULTS: Veterans had diverse individual headache and CHC diagnoses with uniformly high cost of care. Post-whiplash and post-TBI CHCs were common and consistently associated with higher costs after TBI than those with other types of headache and CHCs. Post-TBI migraine had the highest unadjusted mean inpatient ($27,698), outpatient ($61,417), and pharmacy ($4,231) costs, which persisted even after adjustment for confounders including demographic, military, and clinical characteristics. CONCLUSION: Headache diagnoses after TBI, particularly those diagnosed with post-traumatic headache, are complex, and associated with dual high cost and care burdens. More research is needed to examine whether this higher expenditure reflects more intensive treatment and better outcomes or refractory headache with worse outcomes.

Traumatic brain injury rehabilitation for warfighters with post-traumatic stress.

BACKGROUND: While there is extensive empirical support and clinical guidance for the treatment of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) individually, less is known about treating the comorbid presentation of both conditions. OBJECTIVE: The purpose of this review article is to provide information on the mental health treatment needs of service members (SMs) engaged in traumatic brain injury (TBI) rehabilitation. It also aims to offer a framework for an integrated treatment approach to address the cognitive and psychological health needs of warfighters. METHODS: We review the prevalence and outcomes associated with comorbid TBI and PTSD and present relevant access to care considerations. Additionally, we identify an integrated approach to TBI treatment which takes psychological trauma into consideration. We introduce a trauma-informed care (TIC) model with specified diagnostic and treatment considerations for the service member and veteran (SM/V) communities. TIC is a strengths-based framework that raises the system-wide awareness of treatment facilities to the impact of psychological trauma on behavioral health. RESULTS: A comprehensive diagnostic approach is recommended with considerations for symptom etiology. Clinical considerations derived from available guidelines are identified to meet critical treatment needs for SM/Vs presenting for TBI treatment with a remote history of mTBI and psychological trauma or known PTSD. Clinical practice guidelines are used to inform an integrated TBI treatment model and maximize rehabilitation efforts for warfighters. CONCLUSION: Given the prevalence of comorbid TBI and PTSD among SM/Vs and its impact on outcomes, this review presents the integration of appropriate diagnostics and treatment practices, including the incorporation of CPGs into TBI rehabilitation.

Adverse childhood experiences in adults with chronic traumatic brain injury: Support for a life course approach to brain injury rehabilitation.

BACKGROUND: Adverse childhood experiences (ACEs) confer greater risk for adult traumatic brain injury (TBI), but little is known about their effects on post-injury outcomes. OBJECTIVE: To determine the prevalence and correlates of conventionally defined ACEs (occurring within household/in private; e.g., physical abuse) and community-level ACEs (e.g., bullying) after TBI. METHODS: Participants were 85 Philadelphia-area TBI Model System participants with chronic (>1 year post-injury) TBI. We examined cross-sectional associations between total conventional and community ACEs reported (out of 21) before age 18, mental health symptoms, and health-related quality of life (HRQoL), as well as relationships between ACEs and neighborhood deprivation (census-derived neighborhood socioeconomic status). RESULTS: The median number of total ACEs was 3 (range: 0-17). Emotional abuse, physical abuse, and alcohol abuse in the household were the most common conventional ACEs (each at 36.5 %). Witnessing violence (45 %) was the most common community ACE. Black individuals (n = 32) reported more community ACEs (p < .001) than White individuals (n = 45). Community ACEs were significantly associated with greater neighborhood deprivation, though this relationship was confounded by race. Total ACEs was significantly related to more severe mental health symptoms (p < .001) and poorer HRQoL (p = .005), even after covariate adjustment. A fully-adjusted path model supported mental health as a mediator between total ACEs and HRQoL. CONCLUSIONS: Results of this preliminary study reveal an appreciable prevalence and potential far-reaching consequences of conventional and community ACEs among those with chronic TBI. The results underscore the value of trauma-informed and life course approaches to research and clinical care in TBI.

Potential for pulp revascularization in mature anterior teeth with lateral luxation in relation to the patient's age at the time of injury-a retrospective cohort study.

PURPOSE: The aim of this study was to investigate the potential for pulp revascularization in relation to patient age at the time of injury following luxation injury of mature anterior permanent teeth. MATERIALS AND METHODS: A total of 93 teeth from 70 patients were included. The patients were divided into subgroups based on their age at the time of the injury. STATISTICS: the Aalen-Johansen method was used to estimate the risks of pulp canal obliteration (PCO) and pulp necrosis (PN). The absolute 2 year risks of PCO and PN were obtained with cause-specific Cox regression and reported separately for each cohort, standardised to age at injury and degree of repositioning. RESULTS: For the group younger than 15 years of age, the risk of PN after 12 months was 62.3% [95% CI 44.9; 79.7] in the cohort from 1972 to 1980 and 28.6% [95% CI 4.9; 52.2] in the cohort from 2012 to 2020. For the age group 16-20 years, the risk of PN after 12 months was 66.7 [95% CI 40.0;93.3] in the cohort from 1972 to 1980 and 25% [95% CI 0.0;55.0] in the cohort from 2012 to 2020. For the age group between 21 and 25, the risk of PN after 12 months was 66.7% [95% CI 40.0; 93.3] in the cohort from 1972 to 1980 and 55.6% [95% CI 23.1; 88.0] in the cohort from 2012 to 2020. CONCLUSION: There is potential for pulp revascularization in mature anterior teeth with lateral luxation in patients up to 25 years of age. The risk of PN appears to increase with age.