Acute Trauma Factor Associations With Suicidality Across the First 5 Years After Traumatic Brain Injury

Kesinger, Matthew R.; Juengst, Shannon B.; Bertisch, Hillary; Krellman, Jason W.; Pugh, Mary Jo; Kumar, Raj G.; Sperry, Jason L.; Arenth, Patricia M.; Fann, Jesse R.; Wagner, Amy K.

doi:10.1016/j.apmr.2016.02.017

Cited by 22 publications

(23 citation statements)

References 50 publications

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“…19 Also, the methodology and matching criteria have been used to link data from all TBIMS centers with acute care data from the NTDB, and we generated a database that includes matched records for over 3500 individuals in the TBIMS National Database. We have used this matched dataset to examine the influence of extracranial injury on mental health outcomes, 28 and we will explore how other aspects of the acute trauma complex, comorbidities, as well as acute trauma complications and treatments, influence health care utilization and long term outcomes. The long-term goal of this work in TBI is to generate a greater insight into how heterogeneity with individual factors like comorbid burden, as well as how heterogeneity with the polytrauma complex and acute care practices, can influence recovery trajectories for individuals with moderate-to-severity TBI that receive acute rehabilitation services.…”

Section: Discussionmentioning

confidence: 99%

Probabilistic Matching Approach to Link Deidentified Data from a Trauma Registry and a Traumatic Brain Injury Model System Center

Kesinger

Kumar

Ritter

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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Objective There is no civilian TBI database that captures patients in all settings of the care-continuum. The linkage of such databases would yield valuable insight into possible care interventions. Thus, the objective of this article is to describe the creation of an algorithm used to link the Traumatic Brain Injury Model Systems (TBIMS) to trauma data in state and national trauma databases. Design The TBIMS data from a single center was randomly divided into two sets. One subset was used to generate a probabilistic linking algorithm to link the TBIMS data to the center’s trauma registry. The other subset was used to validate the algorithm. Medical record numbers were obtained and used as unique identifiers to measure the quality of the linkage. Novel methods were used to maximize the positive predictive value (PPV). Results The algorithm generation subset had 121 patients. It had a sensitivity of 88% and a PPV of 99%. The validation subset consisted of 120 patients, and had a sensitivity of 83% and a PPV of 99%. Conclusions The probabilistic linkage algorithm can accurately link TBIMS data across systems of trauma care. Future studies can utilize this database to answer meaningful research questions regarding the long-term impact of acute trauma complex on healthcare utilization and recovery across the care-continuum in TBI populations.

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Section: Discussionmentioning

confidence: 99%

Probabilistic Matching Approach to Link Deidentified Data from a Trauma Registry and a Traumatic Brain Injury Model System Center

Kesinger

Kumar

Ritter

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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“…17 A history of substance abuse prior to injury, and drug use at the time of injury, increases the odds of suicidal ideation postinjury. 20,32 A large Danish population study of TBI and suicide demonstrated that substance misuse increased suicide rates across 3 diagnostic groups representing severity of injury: concussion, cranial fracture, and cerebral contusion or traumatic intracranial hemorrhage. 36 Beyond severity of injury, substance use may be an independent risk factor for suicidality.…”

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confidence: 99%

The Association Between Sports- or Physical Activity–Related Concussions and Suicidality Among US High School Students, 2017

Miller

DePadilla

Jones

et al. 2020

Sports Health: A Multidisciplinary Approach

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Background: This study examined the association between sports- or physical activity–related concussions and having seriously considered attempting suicide, made a suicide plan, or attempted suicide (ie, suicidality), and tested potential moderators of the association. Hypothesis: Risk factors such as persistent feelings of sadness or hopelessness, low academic grades, few hours of sleep, and current alcohol or marijuana use will increase the odds of suicidality among those who self-reported sports- or physical activity–related concussions, while protective factors such as physical activity and having played on a sports team will decrease the odds. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: This study used data from the 2017 Youth Risk Behavior Survey, a biennial, school-based, nationally representative survey of US students in grade levels 9 to 12 (N = 14,765). Logistic regression models examined associations between self-reported sports- or physical activity–related concussions and suicidality among the students, and whether physical activity, having played on a sports team, persistent feelings of sadness or hopelessness, academic grades, hours of sleep, or current alcohol or marijuana use moderated those associations. Results: Sports- or physical activity–related concussions were found to be associated with suicidality. The associations remained significant in models that adjusted for demographic characteristics, and they did not appear to be moderated by physical activity, having played on sports team, academic grades, or sleep. Conclusions: Given the findings of this study and others, health care providers are advised to ask students who have experienced a concussion about their emotional well-being as part of their symptom-based assessment, using validated, age- appropriate concussion symptom scales. Comprehensively assessing students who have experienced a sports- or physical activity–related concussion for persistent feelings of sadness or hopelessness may alert providers to thoughts of suicidal ideation and will allow for earlier intervention. Clinical Relevance: If thoughts of suicide are discovered among adolescents with a concussion, or if other risk factors are observed, referrals to medical and mental health providers for a more comprehensive assessment may be warranted.

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“…The importance of early identification of mTBI/concussion is a significant concern, as untreated concussions can contribute to morbidity with potentially debilitating and lingering post-concussive symptoms (including cognitive impairment, development of depression and anxiety, and somatization disorder). 31,32 Additionally, in athletes there is a higher incidence of repeat concussion following a first concussion and an increase chance for worse injury if an athlete is allowed to return to play prior to symptom resolution. 33,34 This head-injured normal validation study demonstrated as a secondary end-point, the potential clinical utility of the EEG BFI in providing important quantitative information about the status of brain function in mTBI relative to an uninjured normal population at the initial point of triage in the emergency setting.…”

Section: Eeg Biomarker Of Brain Function Impairment In Tbi Discussionmentioning

confidence: 99%

A Brain Electrical Activity Electroencephalographic-Based Biomarker of Functional Impairment in Traumatic Brain Injury: A Multi-Site Validation Trial

Hanley

Prichep

Badjatia³

et al. 2018

Journal of Neurotrauma

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The potential clinical utility of a novel quantitative electroencephalographic (EEG)-based Brain Function Index (BFI) as a measure of the presence and severity of functional brain injury was studied as part of an independent prospective validation trial. The BFI was derived using quantitative EEG (QEEG) features associated with functional brain impairment reflecting current consensus on the physiology of concussive injury. Seven hundred and twenty adult patients (18-85 years of age) evaluated within 72 h of sustaining a closed head injury were enrolled at 11 U.S. emergency departments (EDs). Glasgow Coma Scale (GCS) score was 15 in 97%. Standard clinical evaluations were conducted and 5 to 10 min of EEG acquired from frontal locations. Clinical utility of the BFI was assessed for raw scores and percentile values. A multinomial logistic regression analysis demonstrated that the odds ratios (computed against controls) of the mild and moderate functionally impaired groups were significantly different from the odds ratio of the computed tomography (CT) postive (CT+, structural injury visible on CT) group (p = 0.0009 and p = 0.0026, respectively). However, no significant differences were observed between the odds ratios of the mild and moderately functionally impaired groups. Analysis of variance (ANOVA) demonstrated significant differences in BFI among normal (16.8%), mild TBI (mTBI)/concussed with mild or moderate functional impairment, (61.3%), and CT+ (21.9%) patients (p < 0.0001). Regression slopes of the odds ratios for likelihood of group membership suggest a relationship between the BFI and severity of impairment. Findings support the BFI as a quantitative marker of brain function impairment, which scaled with severity of functional impairment in mTBI patients. When integrated into the clinical assessment, the BFI has the potential to aid in early diagnosis and thereby potential to impact the sequelae of TBI by providing an objective marker that is available at the point of care, hand-held, non-invasive, and rapid to obtain.

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Acute Trauma Factor Associations With Suicidality Across the First 5 Years After Traumatic Brain Injury

Cited by 22 publications

References 50 publications

Probabilistic Matching Approach to Link Deidentified Data from a Trauma Registry and a Traumatic Brain Injury Model System Center

Probabilistic Matching Approach to Link Deidentified Data from a Trauma Registry and a Traumatic Brain Injury Model System Center

The Association Between Sports- or Physical Activity–Related Concussions and Suicidality Among US High School Students, 2017

A Brain Electrical Activity Electroencephalographic-Based Biomarker of Functional Impairment in Traumatic Brain Injury: A Multi-Site Validation Trial

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