National Healthcare Quality and Disparities Report
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Search All Research Studies
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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 10 of 10 Research Studies DisplayedLuther M, Poppert Cordts KM, Williams CN
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
This is a systematic review to quantify sleep wake disturbances (SWD) after pediatric traumatic brain injury (TBI). These SWD can place children at risk for worse outcomes since sleep is needed for brain development and healing after injury. They also evaluated interventions for SWD and the association between SWD and other post-traumatic outcomes. Literature was searched from 1999-2019 evaluating sleep or fatigue in children hospitalized for TBI. Two independent reviewers assessed quality of the studies using the Newcastle-Ottowa Score for observational studies. Out of 966 identified articles, 126 full text articles were reviewed and 24 studies were included. Studies showed at least 20% of children with TBI had some degree of SWD including trouble falling or staying asleep, fatigue, daytime fatigue, and nightmares. SWD was negatively correlated with cognitive, behavioral, and quality of life outcomes. There was moderate-high risk of bias for all studies due to small sample size and lack of validated or objective SWD measures.
AHRQ-funded; HS022981.
Citation: Luther M, Poppert Cordts KM, Williams CN .
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
Sleep 2020 Oct;43(10):zsaa083. doi: 10.1093/sleep/zsaa083..
Keywords: Children/Adolescents, Sleep Problems, Brain Injury, Neurological Disorders, Trauma, Risk, Patient-Centered Outcomes Research, Outcomes, Quality of Life, Evidence-Based Practice
Porter A, Brown CC, Tilford JM
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
This study’s objective was to determine if a health insurance disparity exists among pediatric patients with severe traumatic brain injury using data from the National Trauma Data Bank. The Bank contains data from more than 800 trauma centers in the United States. Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+. Procedure codes were used to identify four primary treatment approaches combined into 2 classifications: craniotomy or craniectomy and external or intracranial ventricular draining. Condition at admission was defined including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Scale. Among the cohort of 12,449 patients, 91% had insurance and 9% were uninsured. Children without insurance had worse condition at admission with higher rates of hypotension and higher Injury Severity Score when compared with publicly and privately insured patients. Having insurance was associated with a 32% increase in the odds of cranial procedures, and 54% increase in the odds of monitor placement. Insurance coverage was associated 25% lower odds of inpatient mortality. Further study is needed to determine what factors lead to worse condition at admission.
Citation: Porter A, Brown CC, Tilford JM .
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
Crit Care Med 2020 Jul;48(7):e584-e91. doi: 10.1097/ccm.0000000000004398..
Keywords: Children/Adolescents, Brain Injury, Trauma, Health Insurance, Access to Care, Uninsured, Outcomes
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
Sander AM, Lequerica AH, Ketchum JM
Race/ethnicity and retention in traumatic brain injury outcomes research: a traumatic brain injury model systems national database study.
The purpose of this study was to investigate the contribution of race/ethnicity to retention in traumatic brain injury (TBI) research at 1 to 2 years postinjury. The findings emphasized the importance of investigating retention rates separately for blacks and Hispanics rather than combining them or grouping either with other races or ethnicities. The results also suggested the need for implementing procedures to increase retention of Hispanics in longitudinal TBI research.
AHRQ-funded; HS022134.
Citation: Sander AM, Lequerica AH, Ketchum JM .
Race/ethnicity and retention in traumatic brain injury outcomes research: a traumatic brain injury model systems national database study.
J Head Trauma Rehabil 2018 Jul/Aug;33(4):219-27. doi: 10.1097/htr.0000000000000395..
Keywords: Brain Injury, Racial and Ethnic Minorities, Outcomes, Patient-Centered Outcomes Research, Research Methodologies
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
AHRQ-funded; HS022998.
Citation: Mahmoud L, Zullo AR, Thompson BB .
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Bush RA, Beaumont JL, Liotta EM
Fever burden and health-related quality of life after intracerebral hemorrhage.
In this prospective observational cohort study, the investigators tested the hypothesis that increased burden of fever is independently associated with decreased health-related quality of life (HRQoL) at follow-up. The authors found that each additional day with a fever was predictive of worse HRQoL domains of Cognitive Function and Mobility after intracerebral hemorrhage up to 1 year. They suggest that HRQoL outcomes may be a sensitive and powerful way to measure the efficacy of fever control in future research.
AHRQ-funded; HS023437.
Citation: Bush RA, Beaumont JL, Liotta EM .
Fever burden and health-related quality of life after intracerebral hemorrhage.
Neurocrit Care 2018 Mar 29;29(2):189-94. doi: 10.1007/s12028-018-0523-y..
Keywords: Brain Injury, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research, Quality of Life
Liotta EM, Prabhakaran S, Sangha RS
Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage.
The researchers tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). Their findings support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH.
AHRQ-funded; HS023437.
Citation: Liotta EM, Prabhakaran S, Sangha RS .
Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage.
Neurology 2017 Aug 22;89(8):813-19. doi: 10.1212/wnl.0000000000004249..
Keywords: Patient-Centered Outcomes Research, Treatments, Outcomes, Brain Injury
Humble SS, Wilson LD, McKenna JW
Tracheostomy risk factors and outcomes after severe traumatic brain injury.
The researchers sought to determine risk factors associated with tracheostomy placement after severe traumatic brain injury (TBI) and subsequent outcomes among those who did and did not receive a tracheostomy. They concluded that age and insurance status are independently associated with tracheostomy placement, but not with mortality after severe TBI. Tracheostomy placement is associated with increased survival after severe TBI.
AHRQ-funded; HS013833.
Citation: Humble SS, Wilson LD, McKenna JW .
Tracheostomy risk factors and outcomes after severe traumatic brain injury.
Brain Inj 2016;30(13-14):1642-47. doi: 10.1080/02699052.2016.1199915.
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Keywords: Adverse Events, Brain Injury, Outcomes, Risk, Trauma
Bekelis K, Gottlieb D, Su Y
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
The authors studied elderly Medicare patients who underwent treatment for ruptured cerebral aneurysms. They did not demonstrate a difference in mortality, rate of discharge to rehabilitation, and readmissions between surgical clipping and endovascular coiling of ruptured cerebral aneurysms, although clipping was associated with a slightly longer length of stay.
AHRQ-funded; HS021581.
Citation: Bekelis K, Gottlieb D, Su Y .
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
J Neurointerv Surg 2016 Sep;8(9):913-8. doi: 10.1136/neurintsurg-2015-011890.
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Keywords: Brain Injury, Surgery, Comparative Effectiveness, Outcomes, Elderly
Patel MB, Wilson LD, Bregman JA
Neurologic functional and quality of life outcomes after TBI: clinic attendees versus non-attendees.
This study describes the relationship between TBI patient demographics, quality of life outcome, and functional status outcome among clinic attendees and non-attendees. All participants were telephone surveyed using the Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury (QOLIBRI) scale, and a post-discharge therapy questionnaire. Risk factors for GOSE and QOLIBRI outcomes included age, injury characteristics, clinic attendance, insurance status, post-discharge rehabilitation, and time from injury.
AHRQ-funded; HS013833.
Citation: Patel MB, Wilson LD, Bregman JA .
Neurologic functional and quality of life outcomes after TBI: clinic attendees versus non-attendees.
J Neurotrauma 2015 Jul 1;32(13):984-9. doi: 10.1089/neu.2014.3652..
Keywords: Brain Injury, Registries, Outcomes