National Healthcare Quality and Disparities Report
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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
26 to 50 of 64 Research Studies DisplayedPiantino 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
Wickwire EM, Schnyer DM, Germain A
Sleep, sleep disorders, and circadian health following mild traumatic brain injury in adults: review and research agenda.
A rapidly expanding scientific literature supports the frequent co-occurrence of sleep and circadian disturbances following mild traumatic brain injury (mTBI). In this paper, the authors review relevant literature and present a research agenda to 1) advance understanding of the reciprocal relationships between sleep and circadian factors and mTBI sequelae and 2) advance rapidly the development of sleep-related treatments in this population.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Schnyer DM, Germain A .
Sleep, sleep disorders, and circadian health following mild traumatic brain injury in adults: review and research agenda.
J Neurotrauma 2018 Nov 15;35(22):2615-31. doi: 10.1089/neu.2017.5243..
Keywords: Sleep Problems, Brain Injury, Evidence-Based Practice
Albrecht JS, Perfetto EM, Daniel Mullins C
Safety of antidepressant classes used following traumatic brain injury among Medicare beneficiaries: a retrospective cohort study.
The objective of this study was to compare the risk of several adverse events associated with use of the three most commonly used classes of antidepressants following Traumatic Brain Injury (TBI) in older adults. One of the study’s conclusions was that compared to tricyclic antidepressants, selective serotonin reuptake inhibitor use was associated with increased risk of hemorrhagic stroke.
AHRQ-funded; HS024560
Citation: Albrecht JS, Perfetto EM, Daniel Mullins C .
Safety of antidepressant classes used following traumatic brain injury among Medicare beneficiaries: a retrospective cohort study.
Drugs Aging 2018 Aug;35(8):763-72. doi: 10.1007/s40266-018-0570-2..
Keywords: Adverse Events, Medication, Brain Injury, Elderly, Patient Safety
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
Chen C, Peng J, Sribnick EA
Trend of age-adjusted rates of pediatric traumatic brain injury in U.S. emergency departments from 2006 to 2013.
The objective of this study was to use the 2006(-)2013 Nationwide Emergency Department Sample (NEDS) database to describe trends of age-adjusted rates of pediatric traumatic brain injuries (TBI) treated in U.S. emergency departments. The investigators found that the overall age-adjusted rates of pediatric TBI-related emergency department (ED) visits increased from 2006 to 2013, which was largely caused by pediatric mild TBIs, especially unspecified injury to the head (ICD-9-CM code 959.01) and concussion.
AHRQ-funded; HS024263.
Citation: Chen C, Peng J, Sribnick EA .
Trend of age-adjusted rates of pediatric traumatic brain injury in U.S. emergency departments from 2006 to 2013.
Int J Environ Res Public Health 2018 Jun 5;15(6). doi: 10.3390/ijerph15061171..
Keywords: Brain Injury, Children/Adolescents, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Trauma
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
Callahan ML, Binder LM, O'Neil ME
Sensory sensitivity in operation enduring freedom/operation Iraqi freedom veterans with and without blast exposure and mild traumatic brain injury.
To examine factors associated with noise and light sensitivity among returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with a self-reported history of mild traumatic brain injury (mTBI) due to blast exposure, the researchers compared the self-report of noise and light sensitivity of 42 OEF/OIF Veterans diagnosed with mTBI resulting from combat blast-exposure to that of 36 blast-exposed OEF/OIF Veterans without a history of mTBI.
AHRQ-funded; HS022981.
Citation: Callahan ML, Binder LM, O'Neil ME .
Sensory sensitivity in operation enduring freedom/operation Iraqi freedom veterans with and without blast exposure and mild traumatic brain injury.
Appl Neuropsychol Adult 2018 Mar-Apr;25(2):126-36. doi: 10.1080/23279095.2016.1261867..
Keywords: Brain Injury, Neurological Disorders
Sharp AL, Huang BZ, Tang T
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
The researchers evaluated the association of implementation of the Canadian CT Head Rule on head computed tomography (CT) imaging in community emergency departments (EDs). They found that a multicomponent implementation of the Canadian CT Head Rule was associated with a modest reduction in CT use and an increased diagnostic yield of head CTs for adult trauma encounters in community EDs.
AHRQ-funded; HS021271.
Citation: Sharp AL, Huang BZ, Tang T .
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
Ann Emerg Med 2018 Jan;71(1):54-63.e2. doi: 10.1016/j.annemergmed.2017.06.022.
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Keywords: Brain Injury, Clinical Decision Support (CDS), Decision Making, Emergency Department, Guidelines, Healthcare Utilization, Imaging
Albrecht JS, O'Hara LM, Moser KA
Perception of barriers to the diagnosis and receipt of treatment for neuropsychiatric disturbances after traumatic brain injury.
This study explored perceptions of barriers and facilitators to the diagnosis and receipt of treatment for neuropsychiatric disturbances (NPDs) after traumatic brain injury (TBI). Using semistructured interviews and focus groups, it found that barriers included poor provider education on TBI NPDs and limited access to care due to lack of insurance, transportation, and income. Facilitators included patient education on TBI NPDs and strong caregiver support.
AHRQ-funded; HS024560.
Citation: Albrecht JS, O'Hara LM, Moser KA .
Perception of barriers to the diagnosis and receipt of treatment for neuropsychiatric disturbances after traumatic brain injury.
Arch Phys Med Rehabil 2017 Dec;98(12):2548-52. doi: 10.1016/j.apmr.2017.06.007.
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Keywords: Brain Injury, Caregiving, Diagnostic Safety and Quality, Behavioral Health, Trauma
Albrecht JS, Slejko JF, Stein DM
Treatment charges for traumatic brain injury among older adults at a trauma center.
The objective of this study was to provide charge estimates of treatment for traumatic brain injury (TBI), including both hospital and physician charges, among adults 65 years and older treated at a trauma center. The study provided the first estimates of hospital and physician charges associated with hospitalization for TBI among older adults at a trauma center that will aid in resource allocation, triage decisions, and healthcare policy.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Slejko JF, Stein DM .
Treatment charges for traumatic brain injury among older adults at a trauma center.
J Head Trauma Rehabil 2017 Nov/Dec;32(6):E45-e53. doi: 10.1097/htr.0000000000000297..
Keywords: Brain Injury, Elderly, Healthcare Costs, Hospitalization, Patient-Centered Outcomes Research
Williams CN, Kirby A, Piantino J
If you build it, they will come: Initial experience with a multi-disciplinary pediatric neurocritical care follow-up clinic.
To address morbidities in Pediatric Neurocritical Care survivors, collaboration between Pediatric Neurology and Pediatric Critical Care created a multidisciplinary follow-up clinic providing specialized evaluations after discharge. Clinic referrals applied to all Pediatric Neurocritical Care patients regardless of admission severity of illness. Here, the authors report an initial case series, which revealed a population that is heterogenous in age, ranging from 1 month to 18 years, and in diagnoses.
AHRQ-funded; HS022981.
Citation: Williams CN, Kirby A, Piantino J .
If you build it, they will come: Initial experience with a multi-disciplinary pediatric neurocritical care follow-up clinic.
Children 2017 Sep 19;4(9). doi: 10.3390/children4090083.
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Keywords: Brain Injury, Critical Care, Neurological Disorders, Patient-Centered Healthcare, Children/Adolescents
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
Sangha RS, Naidech AM, Corado C
Challenges in the medical management of symptomatic intracranial stenosis in an urban setting.
The researchers hypothesized that recurrent stroke risk among patients treated with aggressive medical management (AMM) is similar to that found in the medical arm of the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis). However, results indicated that recurrent stroke risk within 30 days in patients with symptomatic intracranial atherosclerotic disease was higher than that observed in the medical arm of SAMMPRIS even in the subgroup receiving AMM.
AHRQ-funded; HS023437.
Citation: Sangha RS, Naidech AM, Corado C .
Challenges in the medical management of symptomatic intracranial stenosis in an urban setting.
Stroke 2017 Aug;48(8):2158-63. doi: 10.1161/strokeaha.116.016254.
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Keywords: Brain Injury, Urban Health, Stroke, Patient-Centered Outcomes Research, Care Management
Chenoweth JA, Johnson MA, Shook L
Prevalence of intracranial hemorrhage after blunt head trauma in patients on pre-injury dabigatran.
Dabigatran etexilate was the first direct-acting oral anticoagulant approved in the United States. The researchers aimed to determine the prevalence of intracranial hemorrhage for patients on dabigatran presenting to a Level I trauma center. The intracranial hemorrhage prevalence in their study was similar to previous reports for patients on warfarin.
AHRQ-funded; HS022236.
Citation: Chenoweth JA, Johnson MA, Shook L .
Prevalence of intracranial hemorrhage after blunt head trauma in patients on pre-injury dabigatran.
West J Emerg Med 2017 Aug;18(5):794-99. doi: 10.5811/westjem.2017.5.33092.
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Keywords: Blood Thinners, Brain Injury, Trauma, Risk, Medication
Sauser Zachrison K, Schwamm LH
Implementation of rapid treatment and interfacility transport for patients with suspected stroke by large-vessel occlusion: in one door and out the other.
This editorial discusses an article in this same issue of JAMA Neurology (McTaggart et al) that describes the results of the implementation of a standard protocol for patients with suspected emergent large-vessel occlusion (ELVO), and the protocol’s impact on both the process of care and patient outcomes. The editorial concludes that the McTaggart article challenges the medical community to develop an interdisciplinary, team-based, protocol-based approach to patients with potential ELVOs, and that work across the disciplines is needed to achieve an acceptable false-positive rate for the system.
AHRQ-funded; HS024561.
Citation: Sauser Zachrison K, Schwamm LH .
Implementation of rapid treatment and interfacility transport for patients with suspected stroke by large-vessel occlusion: in one door and out the other.
JAMA Neurol 2017 Jul;74(7):765-66. doi: 10.1001/jamaneurol.2017.0324..
Keywords: Brain Injury, Health Services Research (HSR), Healthcare Delivery, Stroke, Transitions of Care, Trauma
O'Neil ME, Callahan M, Carlson KF
Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.
This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases (ICD-10) criteria for postconcussional syndrome (PCS) in veterans. One aim was to examine relationships among PCS symptoms by using the British Columbia Postconcussion Symptom Inventory (BC-PSI). BC-PSI factors were interpreted as cognitive, vestibular, affective, anger, and somatic. Items and factor scores were highest for veterans with blast exposure plus mTBI, and lowest for controls.
AHRQ-funded; HS022981.
Citation: O'Neil ME, Callahan M, Carlson KF .
Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.
J Clin Exp Neuropsychol 2017 Jun;39(5):449-58. doi: 10.1080/13803395.2016.1232699.
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Keywords: Brain Injury, Diagnostic Safety and Quality, Behavioral Health, Trauma
Melnick ER, Hess EP, Guo G
Patient-centered decision support: formative usability evaluation of integrated clinical decision support with a patient decision aid for minor head injury in the emergency department.
The study’s objective was to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients' specific concerns. It concluded that the Concussion or Brain Bleed app is a useful and usable final product integrating clinical decision support with a patient decision aid.
AHRQ-funded; HS021271.
Citation: Melnick ER, Hess EP, Guo G .
Patient-centered decision support: formative usability evaluation of integrated clinical decision support with a patient decision aid for minor head injury in the emergency department.
J Med Internet Res 2017 May 19;19(5):e174. doi: 10.2196/jmir.7846.
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Keywords: Brain Injury, Decision Making, Emergency Department, Health Information Technology (HIT), Patient-Centered Healthcare
Albrecht JS, Peters ME, Smith GS
Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury.
This study estimated rates of anxiety and posttraumatic stress disorder (PTSD) diagnoses after traumatic brain injury (TBI) among Medicare beneficiaries. After TBI, 16,519 (17 percent) beneficiaries were diagnosed with anxiety and 269 (0.3 percent) were diagnosed with PTSD. Rates of anxiety and PTSD diagnoses were highest in the first 5 months post-TBI and decreased over time.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Peters ME, Smith GS .
Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury.
J Head Trauma Rehabil 2017 May/Jun;32(3):178-84. doi: 10.1097/htr.0000000000000266.
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Keywords: Anxiety, Brain Injury, Medicare, Behavioral Health, Trauma
Pretz CR, Graham JE, Middleton A
Longitudinal investigation of rehospitalization patterns in spinal cord and traumatic brain injury among Medicare beneficiaries.
The researchers modeled 12-month rehospitalization risk among Medicare beneficiaries receiving inpatient rehabilitation for SCI or TBI in order to create two (SCI- and TBI-specific) interactive tools enabling users to generate monthly projected probabilities for rehospitalization . They found that monthly rehospitalization probabilities for the individual high-risk TBI and SCI cases declined from 33-15% and 41-18%, respectively, over time.
AHRQ-funded; HS022134.
Citation: Pretz CR, Graham JE, Middleton A .
Longitudinal investigation of rehospitalization patterns in spinal cord and traumatic brain injury among Medicare beneficiaries.
Arch Phys Med Rehabil 2017 May;98(5):997-1003. doi: 10.1016/j.apmr.2016.12.012.
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Keywords: Hospital Readmissions, Medicare, Brain Injury, Injuries and Wounds
Albrecht JS, Mullins DC, Smith GS
Psychotropic medication use among Medicare beneficiaries following traumatic brain injury.
The researchers characterized psychotropic medication use before and after traumatic brain injury (TBI) hospitalization among older adults. They found that average monthly prevalence of psychotropic medication use among all patients hospitalized for TBI was 44.8 percent; antidepressants constituted 73 percent. Following TBI, psychotropic medication use increased slightly.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Mullins DC, Smith GS .
Psychotropic medication use among Medicare beneficiaries following traumatic brain injury.
Am J Geriatr Psychiatry 2017 Apr;25(4):415-24. doi: 10.1016/j.jagp.2016.11.018.
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Keywords: Brain Injury, Elderly, Hospitalization, Medication, Behavioral Health
Melnick ER
Big versus small data and the generalizability of the rate of computed tomography overuse in minor head injury.
This correspondence to the editor discusses overuse of computed tomography (CT) in emergency department patients with minor head injury. The authors ask what value a “big data” approach adds to the knowledge in the research examining overuse of CT in minor head injury.
AHRQ-funded; HS021271.
Citation: Melnick ER .
Big versus small data and the generalizability of the rate of computed tomography overuse in minor head injury.
Acad Emerg Med 2017 Mar;24(3):391-92. doi: 10.1111/acem.13084..
Keywords: Brain Injury, Data, Imaging
McDonald V, Hauner KK, Chau A
Networks underlying trait impulsivity: evidence from voxel-based lesion-symptom mapping.
In order to determine the extent to which impulsivity and its components share a common network, a voxel-based lesion-symptom mapping analysis was performed in a large sample of patients with focal, penetrating traumatic brain injuries. The researchers found that heightened global impulsivity was associated with damage to multiple areas in bilateral prefrontal cortex , left superior, middle and inferior temporal gyrus, and left hippocampus.
AHRQ-funded; HS023011.
Citation: McDonald V, Hauner KK, Chau A .
Networks underlying trait impulsivity: evidence from voxel-based lesion-symptom mapping.
Hum Brain Mapp 2017 Feb;38(2):656-65. doi: 10.1002/hbm.23406.
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Keywords: Brain Injury, Imaging, Trauma
Storzbach D, Twamley EW, Roost MS
Compensatory cognitive training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with mild traumatic brain injury.
The purpose of the study was to evaluate the efficacy of group-based compensatory cognitive training (CCT) for veterans with a history of mild traumatic brain injury. Veterans who participated in CCT reported significantly fewer cognitive and memory difficulties and greater use of cognitive strategies. They also demonstrated significant improvements on neurocognitive tests of attention, learning, and executive functioning, which were 3 of the cognitive domains targeted in CCT.
AHRQ-funded; HS022981.
Citation: Storzbach D, Twamley EW, Roost MS .
Compensatory cognitive training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with mild traumatic brain injury.
J Head Trauma Rehabil 2017 Jan/Feb;32(1):16-24. doi: 10.1097/htr.0000000000000228.
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Keywords: Brain Injury, Neurological Disorders, Patient-Centered Outcomes Research, Trauma