Association between impulsivity, self-harm, suicidal ideation, and suicide attempts in traumatic brain injury patients.

Traumatic brain injury (TBI) affects over 48 million people worldwide each year. Suicide is common in TBI, and there are several known contributing factors, including severe TBI, depression, alcohol use, and male sex. Impulsivity, or the tendency to act quickly with little thought, may be an early predictor of suicidality following TBI. The purpose of this study was to evaluate the risk of suicidality in patients with a prior history of impulsivity following a traumatic brain injury (TBI). Using de-identified electronic health records from the TriNetX United States Collaborative Network with Natural Language Processing, three cohorts were generated: the impulsivity TBI cohort (I+TBI+) included subjects with a diagnosis of impulsivity before a diagnosis of TBI; the no impulsivity TBI cohort (I-TBI+) included patients with TBI but no impulsivity; the impulsivity no TBI cohort (I+TBI-) included patients with impulsivity but TBI. Two analyses were conducted, including analysis 1 (impulsivity TBI vs. no impulsivity TBI) and analysis 2 (impulsivity TBI vs. impulsivity no TBI). Patients were 1:1 propensity score matched by age, sex, race, ethnicity, psychiatric diagnoses, and antidepressant use. Outcomes included a diagnosis of self-harm, suicidal ideation, or a suicide attempt within one year after the index event. The all-time incidence of each outcome was assessed across different age categories. The chi-square test (categorical variables) and t-test (numerical variables) were used to assess for differences between groups. A total of 1,292,776 TBI patients were identified in the study. After 1:1 propensity score-matching, there were 20,694 patients (mean [SD] age, 48.1 [21.8]; 8,424 females [40.7%]) with impulsivity and TBI (I+TBI+), 1,272,082 patients (mean [SD] age, 46.0 [23.1]; 562,705 females [44.2%]) with TBI alone (I-TBI+), and 90,669 patients (mean [SD] age, 43.7 [22.6]; 45,188 females [49.8%]) with impulsivity alone (I+TBI-). Within the first year after a TBI, patients with impulsivity were more likely to exhibit self-harm (P < 0.001), suicidal ideation (P < 0.001) or a suicide attempt (P < 0.001). Compared to TBI patients without impulsivity, those with impulsivity had a four-fold increase in the incidence of self-harm (2.81% vs. 0.63%), an eight-fold increase in suicidal ideation (52.42% vs. 6.41%), and a twenty-one-fold increase in suicide attempts (32.02% vs. 1.50%). This study suggests that impulsivity diagnosed before a TBI may increase the risk of post-traumatic suicidality, with a four-fold increased risk of self-harm, an eight-fold increased risk of suicidal ideation and a twenty-one-fold increased risk of suicide attempts. This characterizes a group of at-risk individuals who may benefit from early psychiatric support and targeted interventions following a TBI.

Diagnostic Accuracy of the Yale Swallow Protocol in Moderate-to-Severe Traumatic Brain Injury: A Prospective Blinded Videofluoroscopic Investigation.

OBJECTIVE: The study aimed to assess the accuracy of the Yale Swallow Protocol (YSP) in screening aspiration in adults with acute moderate-to-severe traumatic brain injury (TBI) by comparing the YSP with a videofluoroscopic swallow study (VFSS). SETTING: Level 1 academic trauma center. PARTICIPANTS: The study involved a cohort of 50 consecutive adults with a history of acute moderate-to-severe TBI. DESIGN: The prospective cohort study was conducted between July 2020 and June 2021. Participants underwent the YSP to assess aspiration risk, followed by a VFSS within 5 to 10 minutes after the YSP, to assess the accuracy of the YSP compared with the VFSS. MAIN MEASURE: The accuracy of the YSP in identifying aspiration in adults with acute moderate-to-severe TBI. RESULTS: The interrater agreement for identifying aspiration on the VFSS and the YSP was excellent, as well as 100% agreement between the speech-language pathologists and the radiologist and between the 2 speech-language pathologists, respectively. Of the 50 participants, 16 passed the YSP, while 34 failed. Among those who failed, 30 were confirmed to have aspirated on the VFSS (true-positives) and 4 did not show aspiration on the VFSS (false-positives). The YSP demonstrated a high sensitivity of 96.8%, a specificity of 78.9%, a positive predictive value of 88.2%, and a negative predictive value of 93.8% in identification of aspiration in this cohort. CONCLUSIONS: To date, no dedicated prospective studies have been conducted to assess the utility of the YSP as a screening tool for identifying aspiration risk in persons with moderate-to-severe TBI. The results of this study conclude that the YSP is an effective screening tool for prediction of aspiration in acute care patients with moderate-to-severe TBI due to its high sensitivity and negative predictive value. These factors aid in identification of individuals at risk for aspiration and facilitate timely interventions to prevent complications.

Enhancing safety in the ischaemic and haemorrhagic stroke population: exploring the efficacy of self-releasing chair alarm belts.

INTRODUCTION: A quality improvement study evaluated the effectiveness of implementing self-releasing chair alarm belts in an inpatient rehabilitation facility (IRF) for patients who had a stroke. The objective of this study is to assess the effectiveness of self-releasing chair alarms as a chair-level fall preventive tool in patients who had a stroke in the IRF setting. METHODS: A preintervention and postintervention quality improvement study was conducted in an IRF to address the high rate of falls in the stroke population. Falls from wheelchairs were identified as a significant concern, leading to the implementation of self-releasing safety belts (Posey HeadStart Notification Sensor Belts) with alarm systems as an intervention. In the preintervention phase (July 2021 to January 2022) falls from chairs while on standard fall precautions were recorded to establish a baseline. In the intervention phase, the self-releasing chair alarm belts were introduced along with standard fall precautions. The postintervention phase spanned from February 2022 to July 2022. RESULTS: In the preintervention phase, 20 out of 86 stroke subjects experienced a total of 30 falls from chairs. However, in the postintervention phase, only one subject experienced a fall from a chair out of 104 stroke subjects. The mean percentage of subjects involved in falls decreased from 24±11.4% to 1±0.4% (p<0.00001), and the mean fall rate per 1000 patient days declined from 4.6±2 to 0.2±0.1 (p<0.0001). CONCLUSIONS: The implementation of self-releasing chair alarm belts significantly reduced falls from chairs among patients who had a stroke in the IRF setting. These findings highlight the effectiveness of this intervention in improving patient safety and fall prevention in IRFs.

Timing of withdrawal of life-sustaining therapy in traumatic brain injury: exploring indicators of poor prognosis in adult and geriatric populations.

OBJECTIVE: The lack of objective prognostication tools for severe traumatic brain injury (TBI) causes variability in the application of withdrawal of life-saving treatment (WLST). We aimed to determine whether WLST in persons with severe TBI is associated with known indicators of poor prognosis. METHODS: This retrospective descriptive study focused on adult (18-64 years) and geriatric (≥65 years) patients with severe TBI who were admitted between August 1, 2018 and July 31, 2021 at a Level I trauma center and subsequently underwent WLST. The data collected from the Trauma Registry and electronic health records included information regarding demographic characteristics, injury severity, clinical variables, and length of hospital stay and were used to examine the indicators of poor prognosis and WLST. RESULTS: Among the 164 participants with TBI who met the inclusion criteria, 61.0% were geriatric, and 122 (74.4%) patients had 0 or only 1 of the poor prognostic indicators prior to WLST. The non-geriatric group had more indicators of poor prognosis than the geriatric group. Participants with fewer indicators of poor prognosis had a longer length-of-stay. CONCLUSION: In severe TBI cases, standardized prognostication tools can help guide informed WLST decisions, particularly in geriatric patients, improving care consistency.

Traditional Lecture Versus Procedural Video Randomized Trial: Comparative Analysis of Instructional Methods for Teaching Baclofen Pump Management.

OBJECTIVE: This study compared the effectiveness of traditional lectures and microvideos in teaching baclofen pump programming and refilling to physicians who have completed less than 10 refills for the previous 2 yrs. DESIGN: A mixed-method approach was used with 60 participating physicians specializing in physical medicine and rehabilitation or pain management. Preintervention and postintervention assessments were conducted using a rubric, and the participants' perceptions and preferences were gathered through focus group sessions. RESULTS: Two thirds of the participants specialized in physical medicine and rehabilitation. No significant differences in the preintervention, postintervention, or knowledge retention scores were found between the traditional lecture and microvideo groups. Both methods demonstrated comparable effectiveness in improving the baclofen pump refilling and programming skills. Qualitatively, participants perceived both approaches as equally helpful, but those in the microvideo group raised concerns because of instructors' unavailability and online platform navigation. Nevertheless, they preferred the convenience, accessibility, and time efficiency of the microvideos. CONCLUSIONS: The study concluded that microvideos are an effective alternative to traditional lectures for acquiring knowledge on baclofen pump programming and refilling. Further research should consider learners' characteristics and investigate the benefits of blended learning in medical education.