The Therapy Intensity Level (TIL) scale and its abridged version (TIL(Basic)) are used to record the intensity of daily management for raised intracranial pressure (ICP) after traumatic brain injury (TBI). However, it is uncertain: (1) whether TIL is valid across the wide variation in modern ICP treatment strategies, (2) if TIL performs better than its predecessors, (3) how TIL's component therapies contribute to the overall score, and (4) whether TIL(Basic) may capture sufficient information. We aimed to answer these questions by assessing TIL on a contemporary population of ICP-monitored TBI patients (n=873) in 52 intensive care units (ICUs) across 18 European countries and Israel. From the observational, prospective Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, we extracted first-week daily TIL scores (TIL24), ICP values, physician-based impressions of aberrant ICP, clinical markers of injury severity, and six-month functional outcome scores. We evaluated the construct and criterion validity of TIL against that of its predecessors, an unweighted version of TIL, and TIL(Basic). We calculated the median score of each TIL component therapy for each total score as well as associations between each component score and markers of injury severity. Moreover, we calculated the information coverage of TIL by TIL(Basic), defined by the mutual information of TIL and TIL(Basic) divided by the entropy of TIL. The statistical validity measures of TIL were significantly greater or similar to those of alternative scales, and TIL integrated the widest range of modern ICP treatments. First-week median TIL24 (TILmedian) outperformed first-week maximum TIL24 (TILmax) in discriminating refractory intracranial hypertension (RIC) during ICU stay, and the thresholds which maximised the sum of sensitivity and specificity for RIC detection were TILmedian[≥]7.5 (sensitivity: 81% [95% CI: 77-87%], specificity: 72% [95% CI: 70-75%]) and TILmax[≥]14 (sensitivity: 68% [95% CI: 62-74%], specificity: 79% [95% CI: 77-81%]). The sensitivity-specificity-optimising TIL24 threshold for detecting surgical ICP control was TIL24[≥]9 (sensitivity: 87% [95% CI: 83-91%], specificity: 74% [95% CI: 72-76%]). The median component scores for each TIL24 reflected a credible staircase approach to treatment intensity escalation, from head positioning to surgical ICP control, as well as considerable variability in the use of cerebrospinal fluid drainage and decompressive craniectomy. First-week maximum TIL(Basic) (TIL(Basic)max) suffered from a strong ceiling effect and could not replace TILmax. TIL(Basic)24 and first-week median TIL(Basic) (TIL(Basic)median) could be a suitable replacement for TIL24 and TILmedian, respectively (up to 33% [95% CI: 31-35%] information coverage). Numerical ranges were derived for categorising TIL24 scores into TIL(Basic)24 scores. Our results validate the TIL scale across a spectrum of ICP management and monitoring approaches and support its use as an intermediate outcome after TBI.

BACKGROUND:Adults with intellectual disability (ID) have poorer physical and perceived health than the general population. Knowledge of perceived health predictors is both limited and important for guiding the development of preventive actions. The aims of this study were to investigate (1) the associations between perceived health and demographics, degree of ID, physical health conditions, and weight and physical activity level and (2) lifestyle factors and multimorbidity as predictors for perceived health adjusted for age, gender, and level of ID.METHOD:The North Health in Intellectual Disability study is a community based cross-sectional survey. The POMONA-15 health indicators were used. Univariate and multivariate logistic regression analyses with poor versus good health as the dependent variable were applied.RESULTS:The sample included 214 adults with a mean age 36.1 (SD 13.8) years; 56% were men, and 27% reported perceiving their health as poor. In univariate analyses, there were significant associations between poor health ratings and female gender, lower motor function, number of physical health conditions and several indicators of levels of physical activity. In the final adjusted model, female gender [odds ratio (OR) 2.4, P < 0.05], level of ID (OR 0.65, P < 0.05), numbers of physical health conditions (OR 1.6, P < 0.001) and lower motor function (OR 1.5 P < 0.05) were significant explanatory variables for poor perceived health, with a tendency to independently impact failure to achieve 30 min of physical activity daily (OR 2.0, P = 0.07).CONCLUSION:Adults with ID with female gender, reduced motor function and more physical health conditions are at increased risk of lower perceived health and should be given attention in health promoting interventions. A lack of physical activity tends to negatively influence perceived health.

OBJECTIVE The aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment. METHODS Patients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13–15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire. RESULTS A total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001). CONCLUSIONS Adolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.

textabstractBackground: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n=60, 91%) and designated level I trauma centers (n=44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n=58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n=32, 48%), whereas the others were considered more conservative (n=34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.

The main aim of this study was to evaluate whether the construct validity of the Tampa Scale for Kinesiophobia (TSK) is consistent with respect to its scaling properties, unidimensionality and targeting among workers with different levels of pain. The 311 participating Danish workers reported kinesiophobia by TSK (13 statement version) and number of days with pain during the past year (less than 8 days, less than 90 days and greater than 90 days). A Rasch analysis was used to evaluate the measurement properties of the TSK in the workers across pain levels, ages, genders and ethnicities. The TSK did not fit the Rasch model, but removing one item solved the poorness of fit. Invariance was found across the pain levels, ages and genders. Thus, with a few modifications, the TSK was shown to capture a unidimensional construct of fear of movement in workers with different pain levels, ages, and genders.

Background and purpose: The aim of the study was to examine the predictive value of widely used standardized neuropsychological tests in a clinical setting for on-road driving performance in patients with cerebral stroke or traumatic brain injury (TBI), and to provide cut-off values for neuropsychological test results under which driving should not be recommended.Methods: Data from 78 patients who had undergone comprehensive driving assessment after stroke or TBI were retrospectively included in the analysis. Patients underwent medical examination, neuropsychological testing and on-road assessment. Medical data, demographic variables and neuropsychological performance were used as predictors in a stepwise logistic regression analysis with pass/fail after the on-road test as the dependent variable. Receiver operating characteristic curve analysis was employed to select cut-off values for the tests that were significant predictors for on-road performance.Results: Forty-three patients passed and 35 failed the on-road driving task. Logistic regression analysis revealed three significant neuropsychological tests (CalCap simple reaction time, Trail Making Test A, Grooved Pegboard) as predictors for on-road performance explaining 46% of the variance with an overall classification accuracy of 82.1%. Receiver operating characteristic curve analysis showed the following cutoff values: CalCap, 395 ms; Trail Making Test A, 46 s; Grooved Pegboard, 97.5 s.Conclusion: The results suggest that driving ability after brain damage and cerebral disease with no severe neurological deficits can be measured with a few distinctive neuropsychological tests together with medical examination and on-road assessment. Cut-off scores are a useful supplement to normative data/scaled scores.

Aims: The aims of this study were to assess the incidence of hospital-admitted severe traumatic brain injury (TBI) in the adult population in Norway, and to determine whether there were differences in the epidemiological characteristics of severe TBI between rural and urban regions. Methods: A prospective population-based study on adults with severe TBI admitted to the Norwegian Trauma Referral Centres during the 2-year period (2009–2010). The electronic patient register was searched weekly for ICD-10 diagnoses of intracranial injuries (S06.0–S06.9) to identify patients. Severe TBI was defined as lowest unsedated Glasgow Coma Scale Score ≤8 during the first 24 h after injury. Results: The annual age-adjusted incidence was estimated at 5.2/100,000 in 2009 and 4.1/100,000 in 2010. The highest frequency of hospitalized patients was found among the youngest and the oldest age groups. The most common causes of injury were falls and transport accidents. The highest in-hospital case-fatality rate was found among the oldest patients. There were consistent epidemiological characteristics of severe TBI from both rural and urban regions. Conclusions: The incidence of hospital-admitted patients with severe TBI in this national study supports the declining incidence of TBI reported internationally. No major differences were found in epidemiological characteristics between the urban and rural parts of Norway.