@article{MTMT:33195955, title = {Measurement invariance of six language versions of the post-traumatic stress disorder checklist for DSM-5 in civilians after traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/33195955}, author = {Bockhop, Fabian and Zeldovich, Marina and Cunitz, Katrin and Van Praag, Dominique and van der Vlegel, Marjolein and Beissbarth, Tim and Hagmayer, York and von Steinbuechel, Nicole}, doi = {10.1038/s41598-022-20170-2}, journal-iso = {SCI REP}, journal = {SCIENTIFIC REPORTS}, volume = {12}, unique-id = {33195955}, issn = {2045-2322}, abstract = {Traumatic brain injury (TBI) is frequently associated with neuropsychiatric impairments such as symptoms of post-traumatic stress disorder (PTSD), which can be screened using self-report instruments such as the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The current study aims to inspect the factorial validity and cross-linguistic equivalence of the PCL-5 in individuals after TBI with differential severity. Data for six language groups (n ≥ 200; Dutch, English, Finnish, Italian, Norwegian, Spanish) were extracted from the CENTER-TBI study database. Factorial validity of PTSD was evaluated using confirmatory factor analyses (CFA), and compared between four concurrent structural models. A multi-group CFA approach was utilized to investigate the measurement invariance (MI) of the PCL-5 across languages. All structural models showed satisfactory goodness-of-fit with small between-model variation. The original DSM-5 model for PTSD provided solid evidence of MI across the language groups. The current study underlines the validity of the clinical DSM-5 conceptualization of PTSD and demonstrates the comparability of PCL-5 symptom scores between language versions in individuals after TBI. Future studies should apply MI methods to other sociodemographic (e.g., age, gender) and injury-related (e.g., TBI severity) characteristics to improve the monitoring and clinical care of individuals suffering from PTSD symptoms after TBI.}, year = {2022}, eissn = {2045-2322}, orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:33163294, title = {Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/33163294}, author = {Van Praag, Dominique L G and Wouters, Kristien and Van Den Eede, Filip and Wilson, Lindsay and Maas, Andrew I R}, doi = {10.1016/j.bas.2021.100854}, journal-iso = {BRAIN SPINE}, journal = {BRAIN AND SPINE}, volume = {2}, unique-id = {33163294}, issn = {2772-5294}, abstract = {Neurocognitive problems associated with posttraumatic stress disorder (PTSD) can interact with impairment resulting from traumatic brain injury (TBI).We aimed to identify neurocognitive problems associated with probable PTSD following TBI in a civilian sample.The study is part of the CENTER-TBI project (Collaborative European Neurotrauma Effectiveness Research) that aims to better characterize TBI. For this cross-sectional study, we included patients of all severities aged over 15, and a Glasgow Outcome Score Extended (GOSE) above 3. Participants were assessed at six months post-injury on the PTSD Checklist-5 (PCL-5), the Trail Making Test (TMT), the Rey Auditory Verbal Learning Test (RAVLT) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Primary analysis was a complete case analysis. Regression analyses were performed to investigate the association between the PCL-5 and cognition.Of the 1134 participants included in the complete case analysis, 13.5% screened positive for PTSD. Probable PTSD was significantly associated with higher TMT-(B-A) (OR ​= ​1.35, 95% CI: 1.14-1.60, p ​< ​.001) and lower RAVLT-delayed recall scores (OR ​= ​0.74, 95% CI: 0.61-0.91, p ​= ​.004) after controlling for age, sex, psychiatric history, baseline Glasgow Coma Scale and education.Poorer performance on cognitive tests assessing task switching and, to a lesser extent, delayed verbal recall is associated with probable PTSD in civilians who have suffered TBI.}, keywords = {STRESS; cognition; head injury; neuropsychology; posttraumatic stress disorder}, year = {2022}, orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:32899084, title = {Health care utilization and outcomes in older adults after Traumatic Brain Injury : A CENTER-TBI study}, url = {https://m2.mtmt.hu/api/publication/32899084}, author = {van der Vlegel, Marjolein and Mikolić, Ana and Lee, Hee Quentin and Kaplan, Z L Rana and Retel, Helmrich Isabel R A and van Veen, Ernest and Andelic, Nada and Steinbuechel, Nicole V and Plass, Anne Marie and Zeldovich, Marina and Wilson, Lindsay and Maas, Andrew I R and Haagsma, Juanita A and Polinder, Suzanne}, doi = {10.1016/j.injury.2022.05.009}, journal-iso = {INJURY}, journal = {INJURY: INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED}, volume = {53}, unique-id = {32899084}, issn = {0020-1383}, abstract = {The incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI.We used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury.Of 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms.The rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.}, keywords = {OLDER ADULTS; traumatic brain injury; health-related quality of life; OUTCOMES; mental health; health care utilization}, year = {2022}, eissn = {1879-0267}, pages = {2774-2782}, orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:32668374, title = {Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI) : A CENTER-TBI Analysis}, url = {https://m2.mtmt.hu/api/publication/32668374}, author = {Böhm, Julia K and Güting, Helge and Thorn, Sophie and Schäfer, Nadine and Rambach, Victoria and Schöchl, Herbert and Grottke, Oliver and Rossaint, Rolf and Stanworth, Simon and Curry, Nicola and Lefering, Rolf and Maegele, Marc}, doi = {10.1007/s12028-020-01151-7}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {35}, unique-id = {32668374}, issn = {1541-6933}, abstract = {Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood.This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis.Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to - 6, hypothermia and hypotension increased risk significantly.Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.}, keywords = {Risk Factors; traumatic brain injury; coagulopathy; CENTER-TBI}, year = {2021}, eissn = {1556-0961}, pages = {184-196}, orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:32164324, title = {Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury : a CENTER TBI study}, url = {https://m2.mtmt.hu/api/publication/32164324}, author = {Sewalt, Charlie Aletta and Gravesteijn, Benjamin Yaël and Menon, David and Lingsma, Hester Floor and Maas, Andrew I R and Stocchetti, Nino and Venema, Esmee and Lecky, Fiona E}, doi = {10.1186/s13049-021-00930-1}, journal-iso = {SCAND J TRAUMA RESUS}, journal = {SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION AND EMERGENCY MEDICINE}, volume = {29}, unique-id = {32164324}, issn = {1757-7241}, abstract = {Prehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients.Patients with moderate and severe TBI (Glasgow Coma Scale < 13) from the prospective European CENTER-TBI study were included in this study. All participating hospitals were specialist neuroscience centers. First, adjusted between-country differences were analysed using random effects logistic regression where early secondary referral was the dependent variable, and a random intercept for country was included. Second, the adjusted effect of early secondary referral on survival to hospital discharge and functional outcome [6 months Glasgow Outcome Scale Extended (GOSE)] was estimated using logistic and ordinal mixed effects models, respectively.A total of 1347 moderate/severe TBI patients from 53 SNCs in 18 European countries were included. Of these 1347 patients, 195 (14.5%) were admitted after early secondary referral. Secondarily referred moderate/severe TBI patients presented more often with a CT abnormality: mass lesion (52% vs. 34%), midline shift (54% vs. 36%) and acute subdural hematoma (77% vs. 65%). After adjusting for case-mix, there was a large European variation in early secondary referral, with a median OR of 1.69 between countries. Early secondary referral was not associated with functional outcome (adjusted OR 1.07, 95% CI 0.78-1.69), nor with survival at discharge (1.05, 0.58-1.90).Across Europe, substantial practice variation exists in the proportion of secondarily referred TBI patients at SNCs that is not explained by case mix. Within SNCs early secondary referral does not seem to impact functional outcome and survival after stabilisation in a non-specialised hospital. Future research should identify which patients with TBI truly benefit from direct transportation.}, keywords = {transfer; traumatic brain injury; Referral; trauma system}, year = {2021}, eissn = {1757-7241}, orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:3280066, title = {Blood-Based Protein Biomarkers for the Management of Traumatic Brain Injuries in Adults Presenting with Mild Head Injury to Emergency Departments : A Living Systematic Review and Meta-Analysis}, url = {https://m2.mtmt.hu/api/publication/3280066}, author = {Mondello, S and Sorinola, Abayomi Akinrinsola and Czeiter, Endre and Vámos, Zoltán and Amrein, Krisztina and Synnot, A and Donoghue, EL and Sándor, János and Wang, KKW and Diaz-Arrastia, R and Steyerberg, EW and Menon, D and Maas, A and Büki, András}, doi = {10.1089/neu.2017.5182}, journal-iso = {J NEUROTRAUM}, journal = {JOURNAL OF NEUROTRAUMA}, volume = {38}, unique-id = {3280066}, issn = {0897-7151}, abstract = {Accurate diagnosis of traumatic brain injury (TBI) is critical to effective management and intervention, but can be challenging in patients with mild TBI. A substantial number of studies have reported the use of circulating biomarkers as signatures for TBI, capable of improving diagnostic accuracy and clinical decision-making beyond current practice standards. We performed a systematic review and meta-analysis to comprehensively and critically evaluate the existing body of evidence for the use of blood protein biomarkers (S100B, GFAP, NSE, UCH-L1, Tau and Neurofilament proteins) for diagnosis of intracranial lesions on CT following mild TBI. Effects of potential confounding factors and differential diagnostic performance of the included markers were explored. Furthermore, appropriateness of study design, analysis, quality and demonstration of clinical utility were assessed. Studies published up to October 2016 were identified through a MEDLINE, EMBASE and CINHAL search. Following screening of the identified articles, 26 were selected as relevant. We found that measurement of S100B can help informed decision making in the emergency department possibly reducing resource use, but there is insufficient evidence that any of the other markers is ready for clinical application. Our work pointed out serious problems in the design, analysis and reporting of many of the studies and identi fi ed a substantial heterogeneity and research gaps. These findings emphasize the importance of methodologically rigorous studies focused on a biomarker's intended use and defining standardized, validated and reproducible approaches. The living nature of this systematic review, which will summarize key updated information as it becomes available, can inform and guide future implementation of biomarkers in the clinical arena.}, keywords = {Biomarkers; diagnosis; Meta-analysis; TBI; living systematic review}, year = {2021}, eissn = {1557-9042}, pages = {1086-1106}, orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:31396426, title = {Tracheal intubation in traumatic brain injury : a multicentre prospective observational study}, url = {https://m2.mtmt.hu/api/publication/31396426}, author = {Gravesteijn, Benjamin Yael and Sewalt, Charlie Aletta and Nieboer, Daan and Menon, David Krishna and Maas, Andrew and Lecky, Fiona and Klimek, Markus and Lingsma, Hester Floor}, doi = {10.1016/j.bja.2020.05.067}, journal-iso = {BRIT J ANAESTH}, journal = {BRITISH JOURNAL OF ANAESTHESIA}, volume = {125}, unique-id = {31396426}, issn = {0007-0912}, abstract = {We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity.Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests.In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79-1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65-1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower.The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting.NCT02210221.}, keywords = {Europe; traumatic brain injury; Effectiveness; prehospital; neurological outcome; Tracheal intubation}, year = {2020}, eissn = {1471-6771}, pages = {505-517}, orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:31336762, title = {Informed consent procedures in patients with an acute inability to provide informed consent. Policy and practice in the CENTER-TBI study}, url = {https://m2.mtmt.hu/api/publication/31336762}, author = {van Wijk, Roel P J and van Dijck, Jeroen T J M and Timmers, Marjolein and van Veen, Ernest and Citerio, Giuseppe and Lingsma, Hester F and Maas, Andrew I R and Menon, David K and Peul, Wilco C and Stocchetti, Nino and Kompanje, Erwin J O}, doi = {10.1016/j.jcrc.2020.05.004}, journal-iso = {J CRIT CARE}, journal = {JOURNAL OF CRITICAL CARE}, volume = {59}, unique-id = {31336762}, issn = {0883-9441}, abstract = {Enrolling traumatic brain injury (TBI) patients with an inability to provide informed consent in research is challenging. Alternatives to patient consent are not sufficiently embedded in European and national legislation, which allows procedural variation and bias. We aimed to quantify variations in informed consent policy and practice.Variation was explored in the CENTER-TBI study. Policies were reported by using a questionnaire and national legislation. Data on used informed consent procedures were available for 4498 patients from 57 centres across 17 European countries.Variation in the use of informed consent procedures was found between and within EU member states. Proxy informed consent (N = 1377;64%) was the most frequently used type of consent in the ICU, followed by patient informed consent (N = 426;20%) and deferred consent (N = 334;16%). Deferred consent was only actively used in 15 centres (26%), although it was considered valid in 47 centres (82%).Alternatives to patient consent are essential for TBI research. While there seems to be concordance amongst national legislations, there is regional variability in institutional practices with respect to the use of different informed consent procedures. Variation could be caused by several reasons, including inconsistencies in clear legislation or knowledge of such legislation amongst researchers.}, keywords = {traumatic brain injury; ETHICS; European Union; Informed Consent}, year = {2020}, eissn = {1557-8615}, pages = {6-15}, orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944} } @mastersthesis{MTMT:31672506, title = {Effectiveness of Traumatic Brain Injury Management Guideline Introduction in Hungary and Risk factors of External Ventricular Drain Infection}, url = {https://m2.mtmt.hu/api/publication/31672506}, author = {Sorinola, Abayomi Akinrinsola}, unique-id = {31672506}, year = {2019} } @article{MTMT:30618900, title = {Risk Factors of External Ventricular Drain Infection : Proposing a Model for Future Studies}, url = {https://m2.mtmt.hu/api/publication/30618900}, author = {Sorinola, Abayomi Akinrinsola and Büki, András and Sándor, János and Czeiter, Endre}, doi = {10.3389/fneur.2019.00226}, journal-iso = {FRONT NEUR}, journal = {FRONTIERS IN NEUROLOGY}, volume = {10}, unique-id = {30618900}, issn = {1664-2295}, abstract = {Background: External ventricular drain (EVD) has a major role in the management and monitoring of intracranial pressure (ICP) and its major complication is EVD infection. The risk factors for EVD infection are still a major topic of controversy, hence the need for further research. Objective: The objective of this review was to identify risk factors that affect the incidence of EVD infection and create a model, which can be used in future studies in order to contribute to elaborations on guideline for EVD. Methods: A PubMed and Google Scholar literature search was performed and data were extracted from studies published from 1966 through 2017. The search of the databases generated 604 articles and 28 articles of these were found to be relevant. A manual search of the 28 relevant papers generated 4 new articles. Of the 32 relevant articles, 20 articles that performed a multivariate analysis of the suspected risk factors of EVD infection and had a positive culture as a mandatory component in diagnosis were selected for data collection and analysis. Results: Because reviewed papers investigated only a few influencing factors, and could not determine convincingly the real risk factors of EVD infection and their real strengths. A total of 15 supposed influencing factors which includes: age, age & sex interactions, coinfection, catheter insertion outside the hospital, catheter type, CSF leakage, CSF sampling frequency, diagnosis, duration of catheterization, ICP > 20 mmHg, irrigation, multiple catheter, neurosurgical operation, reduced CSF glucose at catheter insertion and sex were identified. Conclusion: This review summarizes a set of variables which have to be covered by future clinical epidemiological investigations in order to describe the etiological background of EVD infection.}, keywords = {Risk Factors; (EVD) external ventricular drain; EVD infection; ventricular catheter (VC); ventricular catheter infection}, year = {2019}, eissn = {1664-2295}, orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944} }