Correction: Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Correction: Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury.

A correction to this paper has been published and can be accessed via a link at the top of the paper.

Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To assess the impact of mean arterial blood pressure (MAP) during surgical intervention for spinal cord injury (SCI) on motor recovery. SETTING: Level-one Trauma Hospital and Acute Rehabilitation Hospital in San Jose, CA, USA. METHODS: Twenty-five individuals with traumatic SCI who received surgical and acute rehabilitation care at a level-one trauma center were included in this study. The Surgical Information System captured intraoperative MAPs on a minute-by-minute basis and exposure was quantified at sequential thresholds from 50 to 104 mmHg. Change in International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor score was calculated based on physiatry evaluations at the earliest postoperative time and at discharge from acute rehabilitation. Linear regression models were used to estimate the rate of recovery across the entire MAP range. RESULTS: An exploratory analysis revealed that increased time within an intraoperative MAP range (70-94 mmHg) was associated with ISNCSCI motor score improvement. A significant regression equation was found for the MAP range 70-94 mmHg (F[1, 23] = 5.07, r2 = 0.181, p = 0.034). ISNCSCI motor scores increased 0.039 for each minute of exposure to the MAP range 70-94 mmHg during the operative procedure; this represents a significant correlation between intraoperative time with MAP 70-94 and subsequent motor recovery. Blood pressure exposures above or below this range did not display a positive association with motor recovery. CONCLUSIONS: Hypertension as well as hypotension during surgery may impact the trajectory of recovery in individuals with SCI, and there may be a direct relationship between intraoperative MAP and motor recovery.

The Prognosis of Axial vs. Extra-Axial Lesions on Functional Status After Traumatic Brain Injury.

Background: Head computed tomography (CT) scans are widely used in acute head injury for medical triage and surgical decisions, yet there are contradictions on the prognostic value of different head CT classifications. The intra-axial (axial) lesion vs. extra-axial lesion is a well-known systemic classification but has not been applied into clinical practice since there is no evidence-based support for its prognostic value. Hypothesis: Axial injury is related to worse functional independence compared to extra-axial injury at admission to and discharge from acute rehabilitation hospitalization. Design: Observational retrospective study. Settings and participants: Data from 71 participants who were enrolled at an acute rehabilitation hospital in the Northern California Traumatic Brain Injury Model System of Care (NCTBIMS) between 2005 and 2018 were included in the analysis. Main outcome measure and statistical analysis: Results of non-contrast head CT within the first 7 days after injury were analyzed to determine those with axial vs. extra-axial lesions. Functional Independence Measure (FIM) total scores were compared between the axial vs. extra-axial groups at admission and discharge using parametric and non-parametric tests. Results: There were no statistically significant group differences in FIM total scores at rehabilitation admission and discharge between the axial group and extra-axial groups. Conclusion: In this cohort of patients there was no evidence to support the hypothesis that axial injury is related to worse functional independence compared to extra-axial injury at rehabilitation admission and discharge. Utilizing MRI findings or other outcome measures, such as the 10 meter ambulation test or cognitive tests, may provide better sensitivity to potential functional differences.

Burden of Care Implications and Association of Intracranial Hypertension With Extremely Severe Post-traumatic Amnesia After Traumatic Brain Injury: A 5-Year Retrospective Longitudinal Study.

Post-traumatic amnesia (PTA) is characterized by a state of disorientation and confusion following traumatic brain injury (TBI). Few studies have looked at the effect of prolonged PTA on the functional outcomes beyond 1 year post-injury. This study aims to evaluate the burden of care in individuals with extremely severe PTA (esPTA; PTA >28 days) from acute inpatient rehabilitation admission to 5 years post-injury as well as the association between intracranial hypertension (ICH; Intracranial pressure (ICP) ≥20 mmHg) and esPTA status. Three hundred and forty-two individuals with moderate to severe TBI enrolled in the Northern California TBI Model System (TBIMS) of Care were included in this study. The FIM® instrument was chosen as the outcome measurement as it is a widely used functional assessment in the rehabilitation community. Repeated measure ANOVA revealed greater burden of care based on FIM® total scores (p < 0.001) from admission to 5-year follow-up for the esPTA group compared to the non-esPTA group (PTA ≤ 28 days). Unlike the non-esPTA group where FIM® total score plateaued 1 year post-injury, FIM® total score continued to improve up to 2 years post-injury for the esPTA group. The odds of developing esPTA was ~3 times higher for individuals with ICH vs. individuals without ICH (p < 0.001). In conclusion, individuals with esPTA have increased short- and long-term burden of care and the presence of ICH during hospitalization increased the odds of experiencing esPTA. These results may help the rehabilitation team and family in planning care post rehabilitation discharge.

Depression in Men and Women One Year Following Traumatic Brain Injury (TBI): A TBI Model Systems Study.

In the general population, females experience depression at significantly higher rates than males. Individuals with traumatic brain injury (TBI) are at substantially greater risk for depression compared to the overall population. Treatment of, and recovery from, TBI can be hindered by depression; comorbid TBI and depression can lead to adverse outcomes and negatively affect multiple aspects of individuals' lives. Gender differences in depression following TBI are not well understood, and relevant empirical findings have been mixed. Utilizing the Patient Health Questionnaire-9 (PHQ-9) 1 year after TBI, we examined whether women would experience more severe depressive symptoms, and would endorse higher levels of depression within each category of depression severity, than would men. Interestingly, and contrary to our hypothesis, men and women reported mild depression at equal rates; PHQ-9 total scores were slightly lower in women than in men. Men and women did not differ significantly in any PHQ-9 depression severity category. Item analyses, yielded significant gender differences on the following items: greater concentration difficulties (cognitive problems) in men and more sleep disturbances (psychosomatic issues) in women per uncorrected two-sample Z-test for proportions analyses; however, these results were not significant after the family-wise Bonferroni correction. Our results indicate that, in contrast to the general population, mild depression in persons with moderate to severe TBI may not be gender-specific. These findings underscore the need for early identification, active screening, and depression treatment equally for men and women to improve emotional well-being, promote recovery, and enhance quality of life following TBI.