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AHRQ Research Studies Date
Topics
- Adverse Events (2)
- Anxiety (1)
- Behavioral Health (2)
- Blood Clots (1)
- (-) Brain Injury (11)
- Children/Adolescents (3)
- Clinical Decision Support (CDS) (1)
- Depression (1)
- Elderly (5)
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- Outcomes (1)
- Practice Patterns (1)
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- Rehabilitation (2)
- Risk (3)
- Sex Factors (1)
- Shared Decision Making (1)
- Trauma (5)
- Treatments (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedMarks MR, Dux MC, Rao V
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
Investigators examined psychotropic medication use and psychotherapy patterns among individuals diagnosed with anxiety disorders and PTSD post-traumatic brain injury (TBI). They found that receipt of pharmacotherapy pre- and post-TBI was considerably more common than receipt of psychotherapy. Individuals diagnosed with anxiety were 66% less likely to receive psychotherapy compared with individuals diagnosed with PTSD. Overall, psychotropic medication use and rates of antidepressant prescription use in the anxiety group were higher compared to those in the PTSD group.
AHRQ-funded; HS024560.
Citation: Marks MR, Dux MC, Rao V .
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
J Neuropsychiatry Clin Neurosci 2022 Summer;34(3):247-53. doi: 10.1176/appi.neuropsych.21040104..
Keywords: Anxiety, Behavioral Health, Trauma, Brain Injury, Treatments, Practice Patterns, Medication
Greenberg JK, Olsen MA, Johnson GW
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
This study evaluated whether measuring traumatic brain injury size (eg, hematoma size) in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs) improves risk prediction compared with the KIIDS intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model. The cohort included children ≤18 years who presented to 1 of the 5 centers within 24 hours of TBI, had Glasgow Coma Scale scores of 13 to 15, and had ICI on neuroimaging. The data set was split into training and testing cohorts. The generalized linear model (GLM) and recursive partitioning (RP) models showed similar specificity across all risk cutoffs, but the GLM model had higher sensitivity. By comparison, the KIIDS-TBI model had slightly higher sensitivity but lower specificity.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Olsen MA, Johnson GW .
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
Neurosurgery 2022 Jun;90(6):691-99. doi: 10.1227/neu.0000000000001895..
Keywords: Children/Adolescents, Brain Injury, Shared Decision Making
Evans E, Krebill C, Gutman R
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
This retrospective cohort study’s goal was to describe the proportion of older adults with traumatic brain injury (TBI) who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from inpatient rehabilitation facility (IRF) admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status. This study used Medicare administrative data probabilistically linked to the National Trauma Data Bank. The authors found that from IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. A higher probability of achieving the MCID for IM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score but was not associated with the probability of achieving the MCID in FIM-M score.
AHRQ-funded; HS000011.
Citation: Evans E, Krebill C, Gutman R .
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
PM R 2022 Apr; 14(4):417-27. doi: 10.1002/pmrj.12644..
Keywords: Elderly, Rehabilitation, Brain Injury, Inpatient Care
Kumar RG, Zhang W, Evans E
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
The objective of this study was to describe patient, hospital, and geographic characteristics of older adult Medicare beneficiaries who were hospitalized with traumatic brain injury (TBI) then admitted to long-term acute care hospitals. Participants were predominantly White males with an average age of 77.1. Average acute hospital length of stay was 19.4 days. Only 4% of patients were discharged home after a long-term acute care hospital stay; the primary discharge disposition was to skilled nursing facilities. Geographic analyses indicated that Southern and Midwestern states had the greatest number of long-term acute care hospital facilities and highest proportion of admissions. The authors concluded that more research is needed to understand long-term functional outcomes among this population.
AHRQ-funded; HS000011.
Citation: Kumar RG, Zhang W, Evans E .
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
J Head Trauma Rehabil 2022 Mar-Apr; 37(2):89-95. doi: 10.1097/htr.0000000000000685..
Keywords: Elderly, Brain Injury, Long-Term Care
Greenberg JK, Otun A, Kyaw PT
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) is a validated risk prediction model designed to manage children with mild traumatic brain injuries (mTBI) and intracranial injuries. Implementing electronic clinical decision support (CDS) may help integrate this evidence-based guidance into clinical practice. The purpose of this study was to assess the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States participated in usability testing of a novel CDS prototype within a simulated electronic health record environment. The testing involved a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype underwent two updates during testing based on user feedback. Usability issues identified in the videos were categorized using content analysis, while interview transcripts were analyzed using thematic analysis. The study found that of the 20 participants, the majority worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, issues with clarity of terminology and navigation within the CDS interface were identified and resolved. As a result, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3, and the number of errors made dropped from 18 in phase 1 to 2 in phase 3. According to the survey, 90% of participants found the tool easy to use, 95% found the tool useful in determining a patient's level of care, 90% found it likely to improve resource utilization, and 79% found it likely to improve patient safety. Interview themes focused on the CDS's capability to support evidence-based decision-making and enhance clinical workflow, as well as suggested implementation strategies and potential challenges.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Otun A, Kyaw PT .
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
Appl Clin Inform 2022 Mar; 13(2):456-67. doi: 10.1055/s-0042-1745829..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Brain Injury, Health Information Technology (HIT)
Adediran T, Drumheller BC, McCunn M
Sex differences in in-hospital complications among older adults after traumatic brain injury.
This study examined sex differences in in-hospital complications among older adults after traumatic brain injury (TBI). Previous evidence has suggested that women have better outcomes than men after TBI. A retrospective cohort study was conducted of adults aged 65 years and older treated for moderate to severe TBI at R. Adams Cowley Shock Trauma Center from 1996 to 2012. The investigators identified TBI using ICD-9 CM codes and inclusion in the study required an abbreviated injury scale head score of 3 or greater, abbreviated injury scale scores for other body regions of 2 or greater, and a blunt injury mechanism. Out of 2511 patients, 51.1% were men, and 25.1% developed an in-hospital complication. Men had a complication rate of 28.1% versus 22.0% for women.
AHRQ-funded; HS024560.
Citation: Adediran T, Drumheller BC, McCunn M .
Sex differences in in-hospital complications among older adults after traumatic brain injury.
J Surg Res 2019 Nov;243:427-33. doi: 10.1016/j.jss.2019.05.053..
Keywords: Elderly, Sex Factors, Adverse Events, Hospitalization, Brain Injury
Vadlamani A, Perry JA, McCunn M
Racial differences in discharge location after a traumatic brain injury among older adults.
The purpose of this retrospective cohort study was to determine if there were racial differences in discharge location among older adults treated for traumatic brain injury (TBI) at a level 1 trauma center. The authors concluded that in this group of Medicare-eligible older adults, blacks were more likely to be discharged to inpatient rehabilitation compared to whites.
AHRQ-funded; HS024560.
Citation: Vadlamani A, Perry JA, McCunn M .
Racial differences in discharge location after a traumatic brain injury among older adults.
Arch Phys Med Rehabil 2019 Sep;100(9):1622-28. doi: 10.1016/j.apmr.2019.03.008.
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Keywords: Racial and Ethnic Minorities, Brain Injury, Trauma, Elderly, Hospital Discharge, Rehabilitation, Medicare
Glass NE, Vadlamani A, Hwang F
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
The objectives of this study were to evaluate the incidence of bleeding, recurrent traumatic brain injury (TBI), and thromboembolic (TE) events after an initial TBI in older adults and to identify which factors contribute to this risk. The researchers found that, among Medicare patients hospitalized with TBI, the incidence of TE events was significantly higher than that of bleeding or recurrent TBI. They identified specific risk factors of bleeding and TE events, which may guide care of older adults after TBI.
AHRQ-funded; HS024560.
Citation: Glass NE, Vadlamani A, Hwang F .
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
J Surg Res 2019 Mar;235:615-20. doi: 10.1016/j.jss.2018.10.021..
Keywords: Brain Injury, Blood Clots, Elderly, Trauma, Injuries and Wounds, Risk, Adverse Events
Albrecht JS, Barbour L, Abariga SA
Risk of depression after traumatic brain injury in a large national sample.
The goal of this study was to estimate the risk of depression post-traumatic brain injury (TBI) among adults 18 years of age and older and to identify risk factors associated with developing depression post-TBI. Claims data for privately insured and Medicare Advantage enrollees was used. Results showed that history of neuropsychiatric disturbances pre-TBI was the strongest predictor of depression post-TBI. The risk of depression increases substantially post-TBI. Groups at increased risk include those with a history of neuropsychiatric disturbances, older adults, and men. This study highlights the importance of long-term monitoring for depression post-TBI.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Barbour L, Abariga SA .
Risk of depression after traumatic brain injury in a large national sample.
J Neurotrauma 2019 Jan 15;36(2):300-07. doi: 10.1089/neu.2017.5608..
Keywords: Depression, Behavioral Health, Brain Injury, Trauma, Risk
Piantino JA, Lin A, Crowder D
Early heart rate variability and electroencephalographic abnormalities in acutely brain-injured children who progress to brain death.
This study retrospective case-control study explored the hypothesis that lower heart rate variability in brain-injured children is an early indicator of autonomic system failure and predicts progression to brain death. The association between heart rate variability and markers of brain dysfunction between brain-injured children who progressed to brain death and those who survived is also examined. Heart rate variability in patients was estimated using 5-minute electrocardiogram segments. Patients who progressed to brain death exhibited significantly lower heart rate variability in the time and frequency domains. Heart rate variability was significantly lower in those patients with discontinuous or attenuated/featureless electroencephalogram than those with slow/disorganized background. The researchers conclude that these findings support the concept of autonomic system failure as an early indicator of impending brain death, and that decreased heart rate variability is associated with markers of central nervous system dysfunction, such as electroencephalogram abnormalities.
AHRQ-funded; HS022981.
Citation: Piantino JA, Lin A, Crowder D .
Early heart rate variability and electroencephalographic abnormalities in acutely brain-injured children who progress to brain death.
Pediatr Crit Care Med 2019 Jan;20(1):38-46. doi: 10.1097/pcc.0000000000001759..
Keywords: Brain Injury, Children/Adolescents, Neurological Disorders, Outcomes
Albrecht JS, Al Kibria G, Gruber-Baldini A
Risk of mortality in individuals with hip fracture and traumatic brain injury.
Researchers estimated the prevalence of TBI (traumatic brain injury) with individuals hospitalized with hip fracture and their all-cause mortality. The population studied were Medicare beneficiaries aged 65 and older from 2006 to 2010. They concluded that there was a higher risk of death with individuals who had TBI than those who had only a hip fracture.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Al Kibria G, Gruber-Baldini A .
Risk of mortality in individuals with hip fracture and traumatic brain injury.
J Am Geriatr Soc 2019 Jan;67(1):124-27. doi: 10.1111/jgs.15661..
Keywords: Brain Injury, Injuries and Wounds, Mortality, Risk, Trauma