bluuebunny/crossref_metadata_2025 huggingface dataset:
442 Cage Type in Short Segment Transforaminal Lumbar Interbody Fusions is Associated With Alterations in Foraminal Height, but Not Clinical Outcomes
Authors: Gibbs David C. , Viljoen Stephanus , Toop Nathaniel , Maggio Dominic , Oosten James , Deistler Kyle , Gilkey Ty , Farhadi Francis , Grossbach Andrew J.
Published: March 2022

INTRODUCTION:

Steerable “banana” cages have been shown to increase index level segmental lordosis in short-segment transforaminal lumbar interbody fusion (TLIF) procedures. The same is not true for straight “bullet” cages. While this increase in lordosis is generally thought to be advantageous, a theoretical complication is decreased foraminal height leading to worsened clinical outcomes.

METHODS:

We retrospectively reviewed one- and two- level TLIFs at a single tertiary care center between 2012 and 2020 with minimum one-year follow-up. Patient report outcome measures (PROMs), revision rates, and radiographic measurements were compared between two cohorts based on cage morphology.

RESULTS:

48 patients with 56 straight and 93 patients with 129 steerable cages were identified. Steerable cages were associated with an increase in index level segmental lordosis (7.7 vs 11.8°, p < 0.001) and a decrease in foraminal height (20.3 vs 18.4 mm, p < 0.001). Straight cages were associated with a decrease in index level lordosis (8.2 vs 6.3, p = 0.004) and no significant change in foraminal height (19.5 vs 20.2 mm, p = 0.08). Despite these differences, both cohorts reported improved NRS leg, NRS back, RAND SF-36 pain, RAND SF-36 physical functioning, and ODI scores at last follow-up (p = 0.005). One-year revision rates were similar (straight - 4.2%, steerable - 2.2%, p = 0.88) between cohorts.

CONCLUSION:

Steerable cages are associated with increased index level segmental lordosis and decreased foraminal height after TLIF. Straight cages are associated with decreased segmental lordosis, but do not correlate with a significant change in foraminal height. Both cage types are associated with significantly improved clinical outcomes.
448 Revision Rate and Long-Term Outcome After Minimally Invasive Surgical Treatment of Lumbar Adjacent Segment Disease: A Retrospective Review of 176 Adjacent Level Reoperations
Authors: Zhao David , Fayed Islam , Coleman Garrett , Onyiah Amara , Bharil Sarika , Liu Jiaqi , Anaizi Amjad N. , Voyadzis Jean-Marc , Sandhu Faheem A.
Published: March 2022

INTRODUCTION:

The concept of accelerated degeneration at the level adjacent to a fused spinal segment is a well-known and studied phenomenon. Most current surgical paradigms address this with extension of fusion. However, decompression with laminectomy and/or discectomy, particularly with MIS approaches, are viable options.

METHODS:

A single-center retrospective review of consecutive cases from 2013-2020 was performed. All patients who underwent lumbar surgery for ASD were included. The primary outcome was need for revision surgery following either a decompression, microdiscectomy, or instrumented fusion for lumbar ASD. Multivariable regression analysis (chi-square and ANOVA) was performed on demographic, operative, and follow-up data.

RESULTS:

We identified 176 patients who underwent surgery for lumbar ASD with mean follow-up of 9.3 years. 129 patients were treated with fusion, 37 with laminectomy, and 10 with microdiscectomy. In total, 41 patients required revision surgery following their ASD operation: 28 (21.7%) after fusion, 10 (27%) after laminectomy, and 3 (30%) after microdiscectomy (p = 0.697). Symptomatic disc herniation manifested sooner requiring reoperation -- on average 43.8 months (p = 0.006) after index procedure.

CONCLUSION:

There was no significant difference in revision rate among patients undergoing extension of fusion, laminectomy, or discectomy in the treatment of lumbar ASD. Focal adjacent stenosis or disc herniation can be durably treated with MIS laminectomy or discectomy, respectively. Accelerated disc degeneration after discectomy for lumbar ASD may require a subsequent fusion. Lumbar ASD associated with mobile spondylolisthesis should be treated by extension of fusion.
452 Lateral Interbody Fusion Using a 3D Navigation-guided, Prone, Single Position Approach: A Case Series
Authors: Hoffman Samantha , Gupta Saksham , Huang Kevin T. , Klinger Neil , Lu Yi
Published: March 2022

INTRODUCTION:

Interbody fusion via the lateral approach provides certain biomechanical advantages over the posterior approach, including the larger allowable implant size and more anterior implant position. However, current methods for lateral interbody placement require either a two-staged procedure or a lateral single position with limited access to the posterior spine. We present our case series of the first 10 patients who underwent novel single position prone lateral approach, which provides simultaneous full access to the anterior and posterior lumbar spine.

METHODS:

We combined prospective collection of operative and surgical outcome data with retrospective analysis for patients with prone lateral lumbar interbody fusion (Pro-LLIF). Propensity score matching was used to identify 10 control patients who had undergone comparable levels of oblique lateral interbody fusion (OLIF) for comparison.

RESULTS:

Single position prone lateral approach allows both lateral lumbar interbody placement and direct posterior decompression and pedicle screws placement in one position. 3D navigation is utilized to plan lateral spine trajectory and interbody cage placement. Tubular retractors are used for quick and safe access to the retroperitoneal space. Under direct vision, direct psoas muscle dissection is performed and additional retractor pins are placed to minimize risks to the lumbar plexus. Our cohort comprised eight female and two male patients with average BMI of 28.5 and average age of 66.5 years. Average total operative time for Pro-LLIF was 4.5 hours compared to 4.33 hours for OLIF (p > 0.5). Mean estimated blood loss was 240 mL and 262.5 mL for Pro-LLIF and OLIF, respectively (p > 0.5). Pro-LLIF patients did not experience significantly different lengths of stay or discharge rates to rehabilitative facilities.

CONCLUSION:

Single position prone lateral approach provides safe and simultaneous access to lateral interbody cage placement and direct posterior neural decompression and segmental fixation. Efficiency will improve with increased experience with this promising technique.
456 Assessing the Efficacy of the mJOA in Myelopathic Patients: A Cervical QOD Study
Authors: Yee Timothy J. , Upadhyaya Cheerag D. , Coric Domagoj , Potts Eric A. , Bisson Erica F. , Turner Jay D. , Knightly John J. , Fu Kai-Ming G. , Foley Kevin T. , Tumialan Luis M. , Shaffrey Mark E. , Bydon Mohamad , Mummaneni Praveen V. , Chan Andrew K. , Meyer Scott A. , Asher Anthony L. , Shaffrey Christopher I. , Gottfried Oren N. , Than Khoi D. , Wang Michael Y. , Buchholz Avery L. , Park Paul
Published: March 2022

INTRODUCTION:

The modified Japanese Orthopedic Association (mJOA) score is a validated metric for assessing severity of myelopathy. However, its relationship to functional and quality-of-life outcomes after surgery is incompletely known.

METHODS:

The cervical module of the prospectively enrolled Quality Outcomes Database (QOD) was queried. Patients over age 18 who underwent single-stage surgery for CSM were included. Revision and operations for infection, trauma, and tumor were excluded. Postoperative outcomes included the modified Japanese Orthopedic Association (mJOA) score, the Neck Disability Index (NDI), and Quality-Adjusted Life Year (QALY) by EQ-5D. Improvement in mJOA was used as the independent variable in univariate and multivariate linear regression.

RESULTS:

Across 14 surgical centers, 1,121 patients were identified. Mean age±SD was 60.6±11.8 years, and 52.5% were male. Anterior-only operations were performed in 772 patients (68.9%), and posterior-only operations in 349 patients (31.1%). Mean mJOA±SD scores at baseline, 3 months postoperatively, and 12 months postoperatively were 12.0 ± 2.8 (n = 1121), 13.9 ± 2.6 (n = 914), and 13.8 ± 2.8 (n = 801). Mean NDI ± SD scores at baseline, 3 months postoperatively, and 12 months postoperatively were 38.3 ± 20.8 (n = 1117), 23.1 ± 17.9 (n = 942), and 20.4 ± 19.4 (n = 807). Mean QALY ± SD scores at baseline, 3 months postoperatively, and 12 months postoperatively were 0.6 ± 0.2 (n = 1029), 0.7 ± 0.2 (n = 899), and 0.7 ± 0.2 (n = 761). By univariate analysis, improvements in mJOA were associated with improvements in NDI and QALY at 3 and 12 months postoperatively (all p < 0.0001). These findings were similar in multivariate analysis.

CONCLUSION:

In this large cohort of patients who underwent surgery for CSM, improvements in mJOA were associated with improvements in NDI and QALY. These findings suggest that changes in mJOA can serve as a proxy for functional and quality-of-life outcomes.
460 Access to Thrombectomy Capable Stroke Centers in the US: Current Geographic Patterns and Economic Disparities
Authors: Waqas Muhammad , Levy Bennett , Baig Ammad , Cappuzzo Justin M. , Monteiro Andre , Mullin Wallace , Davies Jason , Snyder Kenneth V. , Levy Elad I. , Siddiqui Adnan H.
Published: March 2022

INTRODUCTION:

In the last five years, mechanical thrombectomy has revolutionized the standard of care for patients suffering from acute stroke. The mechanical thrombectomy procedures for removal of clot from large vessel of the brain has been shown to be cost effective compared to the traditional medical therapy. Given the fact that clinical outcomes are strongly dependent on time to recanalization, it is important to examine the socioeconomic disparity of geographic living distance from thrombectomy capable stroke centers (TCC) as related to patient outcomes.

METHODS:

The data on the US population and geographic location of thrombectomy capable stroke centers was obtained from the US Census Bureau and the websites of accrediting agencies and state governments. Using previously validated methods we estimated the population with 1 hour access to TCC. We additionally acquired median household income data for each state in the US. The proportion of population with 1 hour access to TCC was compared between low, middle and high median household states.

RESULTS:

There was a total of 316 TCCs in the analysis, and approximately 65% of all US residents have within one-hour access to a specialized stroke center by way of air or ground. The states with >50% of the population having less than 1-hour access to thrombectomy centers, had the average median income was nearly $10,000 more when compared to states with <50% of the population with 1-hour access to TCC. In high-income states, 69.0% of the population had one-hour access to TCCs. In the middle-income states, 49.5 % of the population had one-hour access to TCCs, while only 21.4 % states one-hour access to TCCs, p-value = 0.01. A positive and significant relationship between economic status and percentage population with one-hour access was observed (r = 0. 44, p-value = 0.01).

CONCLUSION:

One-hour access to thrombectomy capable stroke centers is available to 65% of the US residents. A positive and significant relationship between economic status and percentage population with one-hour access was observed.
461 The Utility of Remote Video Technology in Continuing Neurosurgical Care in the COVID-19 Era: Reflections From the Past Year
Authors: Sharma Akshay , Winkelman Robert , Schlenk Richard P. , Rasmussen Peter A. , Angelov Lilyana , Benzil Deborah L.
Published: March 2022

INTRODUCTION:

The 2020 COVID-19 pandemic exposed existing stressors in the neurosurgical care infrastructure in the United States.

METHODS:

Several distance-health and audio-visual innovations were implemented that expanded neurosurgical care and education at our institution, including use of remote video technology to facilitate inpatient consultations and outpatient ambulatory virtual visits, optimize our regional hospital neurosurgical coverage, expand our interdisciplinary patient management conferences (i.e. Tumor Board), and further enhance our neurosurgical resident education program. Enterprise patient-experience data was queried for outpatient visits in the department of neurosurgery to evaluate patient satisfaction following the switch to virtual visits.

RESULTS:

Between January of 2020 and April of 2021 our department of Neurosurgery more than doubled the utilization of virtual visit following pandemic restrictions.Our survey of 10,772 patient following outpatient visits between April 2020 and March 2021 showed that virtual visitation was equal if not better in providing satisfactory and compassionate patient care. Further, after switching our interdisciplinary spine tumor board to virtual, we increased surgeon participation and attendance by 49.29%. We also found that the integration of remote audio-visual technology in resident didactics and clinical training expanded our ability to provide a comprehensive and personalized educational experience for our trainees.

CONCLUSION:

Distance-health technology has improved our ability to provide care and comprehensive training at our institution. Our investment in the infrastructure required for these remote audio-visual services during the pandemic can facilitate the expansion of neurosurgical care provision for patients across the United States in the future. As we progress, governing bodies within organized neurosurgery should advocate for the continued financial and licensing support of theses service on a national fiscal and policy level.
468 Team Sport Participation Protects Against Burnout During Neurosurgery Training
Authors: Yengo-Kahn Aaron M. , Grimaudo Heather C. , Tonetti Daniel , Burns Carter , Bonfield Christopher M. , Dewan Michael C. , Wellons John C. , Chitale Rohan V. , Chambless Lola B. , Zuckerman Scott L.
Published: March 2022

INTRODUCTION:

Burnout is experienced by up to two-thirds of neurosurgery residents. Team sport participation as an adolescent or young adult has been shown to protect against adverse mental health outcomes (e.g. depression or anxiety) in adulthood.

METHODS:

A cross-sectional survey study of neurosurgery residents enrolled in U.S. programs was conducted between 6/2020-2/2021. Variables collected through surveys included demographics, weekly exercise, and prior team sport participation, defined as an organized team sport at the high school or collegiate level, even if performed individually (i.e. track/golf). Outcomes included ratings of feelings of sadness, anxiety, stress, burnout, optimism and fulfillment on 100-point scales, with 100 being “I constantly feel this during the day.” Individual measures were significantly correlated (r > 0.35, p < 0.0005) and averaged into a composite outcome - "Burnout Composite Score" (BCS). A three-way ANOVA tested the effects of resident level, exercise days and team sport participation on BCS.

RESULTS:

Of 229 submitted responses, 228 (99.5%) provided complete data. Overall, 185 (81.1%) residents had participated in team sports. Weekly exercise days was similar across groups (2.5±1.8 vs 2.1 ± 1.8, p = 0.20). The team sports group reported lower mean BCS (37.14 vs 43.57, p = 0.030, Cohen’s d = 0.369). There was a significant interaction between team sports and exercise regimen on BCS (F(3,211) = 3.39, p = 0.019, n2 = 0.046). Post-hoc analyses demonstrated more exercise days per week was associated with decreased BCS for prior team sport athletes (F(3,211) = 11.10, p < 0.0005), but not for non-participants (F(3,211) = 0.476, p = 0.699). Team sport participation was associated with a larger reduction in BCS among senior residents (11.46 pts, p = 0.016), than junior residents (4.33 pts, p = 0.29).

CONCLUSION:

Prior team sport participation was associated with lower BCS, an effect more pronounced during senior residency, where residents assume formalized leadership responsibilities. Lessons imparted during early team sport experience may have profound impacts on reducing burnout throughout a seven-year neurosurgery residency.
469 The Role of Social Determinants of Health in Child Mortality and Survival Following Abusive Head Trauma
Authors: Singer Timothy , Warner Claire , Mehl Steven , Cain Cary , Kralik Stephen F. , Orman Gunes , Desai Nilesh , Sarpong Kwabena , Donaruma Marcella , Huisman Thierry , Naik-Mathuria Bindi , Weiner Howard L. , Risen Sarah , Donoho Daniel
Published: March 2022

INTRODUCTION:

Abusive Head Trauma (AHT) is a leading cause of preventable pediatric death in the United States, with mortality rates as high as 30. Although population-based studies implicate the Social Determinants of Health (SDOH), “the conditions in the environments where people are born, live, learn, work, play, worship, and age,” as risk factors for AHT mortality, patient-level series have not been widely reported. Examining patient-level SDOH data could provide valuable information for targeted interventions to prevent AHT mortality.

METHODS:

We included children <5 years with expert-confirmed AHT at our freestanding children's hospital from 3/2018-2/2021. Demographic, social, and clinical data were excerpted. Pediatric neuroradiologists reviewed imaging. Descriptive and inferential analyses were conducted with RStudio.

RESULTS:

Of 103 patients with AHT, 19 (18.4%) died and 84 (82.6%) survived. The cohorts were demographically similar. Housing status was not significantly different. Prior interactions with a social worker (11% vs 19%), Child Protective Services (42% vs. 32%), and law enforcement (44% vs. 32%) were frequently observed but not significantly different. Health access measures including insurance status and established care with a pediatrician were similar. Deceased children were more likely to have mothers who were jobless 64% vs. 40%, p = 0.042). Mothers of deceased children were younger (22 vs. 25 years, p = 0.038). Clinically, a strong association was observed between in-hospital mortality and injury severity on presentation (Glasgow Coma Scale, Injury Severity Score, Abbreviated Injury Scale), intubation, presence of hypoxic-ischemic injury, and percent of hospitalization in the intensive care unit. Frequency of neurosurgical intervention was equal between cohorts (32% vs. 23%, p = 0.39).

CONCLUSION:

Adverse SDOH were observed frequently in both cohorts, often at levels far exceeding state and national averages. Children who died from AHT were more likely to have younger, unemployed mothers.
472 Effects of Recurrent Mild Traumatic Brain Injuries on Incidence, Severity, and Recovery of Concussion in Young Student-Athletes
Authors: Hannah Theodore , Spiera Zachary , Li Adam Y. , Dreher Nickolas , Ali Muhammad , Marayati Naoum F. , Lovell Mark R. , Choudhri Tanvir
Published: March 2022

INTRODUCTION:

Currently, it is known that athletes who sustain recurrent concussions are at an increased risk for long-term neurological consequences. Moreover, in the short term, athletes with a history of concussions are significantly more likely to sustain future concussions. Although the increased incidence of mTBI among athletes with a history of concussions has been well documented, there is less consensus about how recurrent concussions affect the severity and recovery of the next head trauma.

METHODS:

Data from 11 563 ImPACT baseline evaluations of US student-athletes aged 12 to 22 years were separated into 2 cohorts: subjects reporting 2 or more previous concussions (PC; n = 976 baseline evaluations) at baseline and a control group reporting zero previous concussions (CT; n = 7743 baseline evaluations). Subjects reporting 1 prior concussion were excluded. Differences in SND incidence, severity, and recovery between the 2 cohorts were assessed using chi-squared tests, t tests, survival analyses, and multivariate regressions.

RESULTS:

The PC cohort had a higher incidence of head injury leading to ImPACT (436.7 per 1000 person-years vs 194.4 per 1000 person-years, P < .0001) and a higher incidence of SND (140.4 vs 71.8, P < .0001) than controls. However, the Severity Index (SI) demonstrated that SND severity was lower in the PC group (7.55 vs 8.59, P = .04). Adjusted analyses similarly demonstrated that the PC cohort had increased SND incidence (odds ratio = 1.93; 95% CI, 1.61 to 2.31; P < .0001), decreased SI (β = −1.37; 95% CI, −2.40 to −0.34; P = .009), and equivalent recovery (hazard ratio = 0.98; 95% CI, 0.76 to 1.72; P = .90).

CONCLUSION:

Participants with a history of concussion have a higher incidence of SND but present with lower severity SND, which may be a result of increased concussion education or symptom awareness. Recurrent concussion has no significant impact on acute neurocognitive recovery. Together, these results provide evidence against the supposition that a history of concussion increases the severity of future SND.
473 The Impact of Frailty on Traumatic Brain Injury Outcomes: An Analysis of 691,821 Nationwide Cases
Authors: Tang Oliver Y. , Shao Belinda , Kimata Anna , Sastry Rahul , Asaad Wael
Published: March 2022

INTRODUCTION:

Earlier research has demonstrated that patient frailty, a decline in physiologic reserve, is associated with higher morbidity and mortality for several neurosurgical conditions. However, the impact of frailty on traumatic brain injury (TBI) outcomes is poorly characterized.

METHODS:

We identified all adult admissions for traumatic intracranial hemorrhage (tICH) in the National Trauma Data Bank from 2007-2017. Frailty was quantified via the validated mFI-5 metric (0-5), with mFI-5 =2 denoting frailty. Analyzed outcomes included in-hospital mortality, favorable discharge disposition (discharge home or to short-term care), complications, ventilator days, and intensive care unit (ICU) and total length of stay (LOS). Multivariable regression was used to assess the association between mFI-5 and outcomes, adjusting for patient demographics (age, sex, insurance, transfer status), hospital characteristics (teaching status, trauma center level, bed size), injury severity on admission (penetrating injury, Glasgow Coma Scale [GCS], Injury Severity Score, hypotension, number of tICH subtypes), and neurosurgical procedures.

RESULTS:

691,821 tICH admissions were analyzed. 63.2% were male and average age was 57.6 years (standard deviation=21.2). 43.5% were above 65 years of age. 18.0% of patients were classified as frail (mFI-5 = 2), and the percentage of frail patients grew from 7.9% in 2007 to 21.9% in 2017. Frailty was associated with increased odds of mortality (odds ratio [OR] = 1.36, P < 0.001) and decreased odds of favorable discharge disposition (OR = 0.72, P < 0.001). Frail patients also exhibited an elevated rate of complications (OR = 1.06, P < 0.001), including unplanned return to the ICU (OR = 1.55, P < 0.001) and operating room (OR = 1.17, P = 0.003). Finally, ventilator days (+12%, P < 0.001), ICU LOS (+11%, P < 0.001), and total LOS (+13%, P < 0.001) were significantly higher in frail patients. All associations with death and disposition remained significant following stratification for age, polytrauma, ICU stay, and GCS on admission.

CONCLUSION:

For tICH patients, frailty was associated with elevated mortality, unfavorable discharge disposition, complications, ventilator days, and LOS, regardless of age or injury severity. Further research into integrated care pathways for this high-risk population is warranted.
474 Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians With Subdural Hematomas
Authors: Kashkoush Ahmed , Petitt Jordan , Ladhani Husayn , Ho Vanessa , Kelly Michael L.
Published: March 2022

INTRODUCTION:

Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS), pupil non-reactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly.

METHODS:

A prospectively collected multi-center database of 3,279 TBI admissions to 45 different U.S. trauma centers between 2017-2019 was queried to identify patients >79 years old presenting with SDH. Factors collected included baseline demographic data, past medical history, antiplatelet/anticoagulant use, and clinical presentation (GCS, pupil reactivity, injury severity scale [ISS]). Primary outcome data included hospital mortality/discharge to hospice care and withdrawal of life-sustaining measures. Multivariate logistic regression analyses were used to identify factors independently associated with primary outcome variables.

RESULTS:

A total of 695 patients were isolated for analysis. Of the total cohort, the rate of hospital mortality or discharge to hospice care was 22% (n = 150) and the rate of withdrawal of life-sustaining measures was 10% (n = 66). A multivariate logistic regression model identified GCS <13, pupil non-reactivity, increasing ISS, intraventricular hemorrhage, and neurosurgical intervention as factors independently associated with hospital mortality/hospice. Congestive heart failure (CHF), hypotension, GCS <13, and neurosurgical intervention were independently associated with withdrawal of life-sustaining measures.

CONCLUSION:

Poor GCS, pupil non-reactivity, ISS, and intraventricular hemorrhage are independently associated with hospital mortality or discharge to hospice care in patients >80 years with SDH. Pre-existing CHF may further predict withdrawal of lifesustaining measures.
480 Deep Learning Analysis of Early MRI Scans After Severe Traumatic Brain Injury Predicts Long-term Outcomes
Authors: Pease Matthew , Arefan Dooman , Puccio Ava , Roy Souvik , Nwachuku Enyinna , Wu Shandong , Okonkwo David O.
Published: March 2022

INTRODUCTION:

Nearly three quarters of deaths in clinical trials of severe traumatic brain injury (TBI) occur due to withdrawal of life sustaining therapies, often due to perceived poor neurological prognosis. Most of these deaths occur within the first week when physicians historically lack enough accuracy to make these decisions. Prognostic models, such as the International Mission for Prognosis and Analysis of Clinical Trials in TBI, are designed to prognose outcomes upon admission and fail to utilize clinical information accumulated after admission. Quantitative prognostic models capturing this informaiton are needed to help guide care decisions.

METHODS:

We built our model using 266 patients from a prospective database of severe TBI patients from 2002 through 2018 with an MRI obtained 1 to 9 days post-trauma. We developed a customized, multi-channel, deep convolutional neural network model with an AlexNet backbone and pre-trained with ImageNet. The cohort was split into 80% training, 10% validation, and 10% independent testing set. We built separate models using T2 FLAIR and DWI sequences. To reduce the heterogeneity of imaging after a decompressive hemicraniectomy (DHC), we only used DHC patients for model training.

RESULTS:

No adverse clinical events occurred while obtaining early MRIs. The overall mortality was 25% (68) and 20% (34) in the 170 patients who did not have a DHC. In the independent test cohort, the T2 FLAIR model performed best, with an area under the curve (AUC) of 0.80 (95% Confidence Interval: 0.57-0.94) and accuracy of 83%. The DWI model had an AUC of 0.64 (0.50 – 0.79) with an accuracy of 78%. With a specificity of 100% (i.e., never recommending withdrawal of care in a patient who would otherwise survive), the sensitivity for mortality was 57%. For identifying patients with favorable recovery potential, the sensitivity was 83% with a specificity of 80%.

CONCLUSION:

Early MRIs are safe to obtain in the severe TBI patient population. Deep learning analysis of these MRIs can predict 6-month mortality to help guide neurological prognostication.
483 Improvement in Behavioral, Cellular and Molecular Outcomes with Connexin Inhibitors Administration in a Porcine Spinal Cord Injury Model
Authors: Alok Khaled , Moussalem Charbel , Minassian Georges , Baassiri Wassim , Kobeissy Firas , Jurjus Abdo , Hamade Eva , Ayoub Abeer J. , Habib Aida , Fahs Assil , El Houshiemy Mohamad N. , Bsat Shadi , Alomari Safwan , Omeis Ibrahim
Published: March 2022

INTRODUCTION:

Connexin inhibition has demonstrated promising results in rodents spinal cord injury models (SCI) as a neuroprotective strategy that improves SCI outcomes. However, it has not been tested in a larger animal yet, a necessary step before conducting a human clinical trial.

METHODS:

SCI was induced using a compression/contusion weight drop model in three groups of pigs with 2 animals per group. Group A: control, Group B: treated with nonselective gap junctions blocker: Carbenoxolone, Group C: treated with connexin-43 memetic peptide: Gap26. All medications were delivered intrathecally at the time of injury. We assessed the locomotor development of the animals over 11 weeks. After which the animals were euthanized and their spinal cords were harvested for histological and immunofluorescence assessment.

RESULTS:

Treatment with intrathecal connexins inhibitors improved SCI outcomes. In terms of locomotion recovery, Groups B and C regained the stepping ability in their hind limbs, whereas the control group did not. Similarly, groups B and C exhibited a decreased level of astrocytes activation at the injury site, and their PGE2 serum levels remained low in the two treated groups. The histological damage was particularly limited in Gap 26-treated group (C).

CONCLUSION:

We translated the positive neuroprotective effect of a connexin-43 mimetic peptide and a gap junction blocker in a porcine SCI model. This study supports the potential role of these agents in improving SCI outcome.
485 Identifying the Minimum Clinically Important Differences (MCID) in ISNCSCI Score for Patients with Traumatic Spinal Cord Injury: An Analysis from the National Spinal Cord Injury Model Systems (SCIMS) Database
Authors: Yolcu Yagiz , Doherty Ronan , Michalopoulos Giorgos , Ghaith Abdul K. , Shah Nilay , Garlanger Kristin , Madigan Nicolas , Bydon Mohamad
Published: March 2022

INTRODUCTION:

Spinal Cord Injury (SCI) is a major cause of disability, mostly presenting due to a traumatic event such as a motor vehicle accident or a fall. To evaluate and follow-up the neurological recovery for patients with SCI, several scales, and scoring systems have been published with the collaborative multidisciplinary efforts, including the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Identifying an MCID for this scoring system is crucial to evaluate patient improvement and provide hints about the success of any intervention.

METHODS:

National Spinal Cord Injury Model Systems Database was queried from 2001-2016 for patients admitted to rehabilitation centers following traumatic spinal cord injury. The following methods were used to identify MCIDs; (i) anchor-based methods where an outcome measure is selected to be the “anchor” (Functional Independence Measure) and defined changes in this anchor is linked to the changes in the investigated outcome measure (ISNCSCI motor scores) and (ii) distribution-based methods where several different parameters (Standard error of measurement, half standard deviation, etc.) are used determine one MCID.

RESULTS:

A total of 1,521 patients were identified. MCIDs for the overall cohort ranged from 3.25 to 6.6 for the anchor-based methods and 0.93 to 5.30 based on the distribution-based methods. Although slight changes were seen, the range of MCIDs was found to be similar to the overall cohort when cohorts were stratified by sex, the level of injury, complete/incomplete injury, and different age groups. The highest MCID was detected for patients with cervical injury in both anchor-based (9.03) and distribution-based approaches (6.06), while the lowest MCID was detected for patients with thoracic injury in both anchor-based (1.0) and distribution-based approaches (0.23).

CONCLUSION:

Our findings demonstrated similar results with regards to MCIDs for ISNCSCI scoring between different patient profiles (stratified by sex, the level of injury, complete/incomplete injury, and age groups) with scores ranging from 0.23 to 9.09 based on different approaches. Anchor-based methods provided higher MCIDs overall when compared to distribution-based methods.
486 Patients Who Die, Then Talk: Outcomes in Patients with Traumatic Extra-Arachnoid Subdural Hematoma
Authors: Eaton Jessica C. , Meyer R. Michael , Greil Madeline , Young Christopher C. , Temkin Nancy , Barber Jason , Bonow Robert H. , Chesnut Randall M.
Published: March 2022

INTRODUCTION:

A critical step in the management of TBI patients is evaluating for lesions that require urgent surgical evacuation. Amongst the most common of these surgical lesions are subdural hematomas (SDH). A subset of patients with SDH have purely extra-arachnoid lesions (EASDH). These patients present in similarly grave neurologic condition as the general SDH hematoma population.

METHODS:

This is a single-center prospective cohort of patients presenting with EASDH from January 2015 to December 2016. The senior author, an neurosurgical trauma subspecialist, made the determination of EASDH versus mixed subarachnoid and SDH based on the patient’s CT scan. Controls from the TRACK-TBI database who had SDH as well as either subarachnoid or other parenchymal injuries were included.

RESULTS:

A total of 49 patients with EASDH were compared to 246 controls. There were no significant differences in baseline demographics between the groups. A significant difference in midline shift was noted. After controlling for midline shift, EASDH patients had 5.68 greater odds of having a better 2-week GOS-E. The expected two-week mortality, as predicted by the CRASH model, was similar between the two groups, but the EASDH group fared much better than the predicted mortality, at 10%.

CONCLUSION:

Patients with EASDH represent a unique clinical entity. They are often elderly and have large lesions with significant midline shift. However, patients often have a dramatic improvement.
489 Time to Following Commands and Favorable Recovery After Severe Traumatic Brain Injury
Authors: Deng Hansen , Nwachuku Enyinna , Wilkins Tiffany , Yue John K. , Fetzick Anita L. , Chang Yue-Fang , Beers Sue , Okonkwo David O. , Puccio Ava
Published: March 2022

INTRODUCTION:

Accurate prognostication after severe traumatic brain injury (TBI) is crucial to goals-of-care discussions and assisting with difficult medical decisions. The capacity to follow commands indicates clinical arousal from unconsciousness and higher level of cognitive function. While it is a predictor of good outcome, time to following commands after injury can widely vary.

METHODS:

Consecutive participants from 2003-2018 were recruited at the Brain Trauma Research Center (BTRC) using IRB-approved prospective observational study design. Inclusion criteria were age 16-80 years, Glasgow Coma Scale (GCS) score =8 and motor GCS score <6, and Glasgow Outcome Scale - Extended (GOS-E) measure =4 at 2 years post injury. Interquartile range (IQR), mean increases/decreases (B), and 95% confidence intervals (CIs) were reported. Statistical significance was assessed at p=0.05.

RESULTS:

A total of 580 patients were enrolled in the BTRC from 2003-2018. There were 229 (39.5%) deaths, and 140 (24.1%) patients had favorable outcomes on the GOS-E at 24 months. Average age was 33.7±14.5 years old, median GCS was 7 (IQR 6-7), and median Injury Severity Score (ISS) was 30 (IQR 26-38). Mean time to following commands was 12.7±11.8 days, median GOS-E at 2 years was 6 (IQR 5-7). On multivariate regression, evidence of diffuse axonal injury (DAI) (B=9.2 days [4.8,13.7], p<0.0001) or intraventricular hemorrhage (IVH) (B=6.4 days [0.5,12.3], p<0.035) was associated with longer time to following commands, and patients who developed nosocomial infections (B=6.5 days [1.6-11.4], p<0.01).

CONCLUSION:

The majority of patients with favorable recovery after severe TBI began to follow commands by 2 weeks. Evidence of DAI, IVH, or nosocomial infections delay cognitive improvement in the acute period during hospitalization. These patients make considerable recovery after discharge and continue to benefit from long-term tailored rehabilitation.
490 Sublaminar Sutures for Stabilization and Fusion of a C3-4 Fracture Dislocation in a 11-Month-Old Infant
Authors: Winter Kenneth A. , Kim Patrick , Smith Andrew , Smalley Zachary , Weaver Kristin J. , Shiflett J. Mason , Tullis Jason E.
Published: March 2022

INTRODUCTION:

Pediatric spinal cord injuries (SCI) are an uncommon occurrence with a rate of 1.99 cases per 100,000 children in the United States. Sub-axial SCIs are even rarer and thus, techniques for fixation are limited. Lateral mass screws are not feasible in infants and toddlers due to limited bone volume. We describe a successful stabilization of a C3/4 fracture dislocation in a 3-month-old using sublaminar sutures.

METHODS:

A standard midline incision and subperiosteal dissection was used to expose C3 to C5. The ligamentum flavum was released and the blunt end of non-absorbable braided polyester sutures were passed under the lamina. Sutures were preferred over wiring due to its tensile properties. In fragile infant bone, sutures are more likely to avoid bony laceration in the lamina, especially during reduction. Sutures were passed in tandem fashion bilaterally, from C2-C4, C3-C5 then C3-C4. Sutures were tied confirming reduction under fluoroscopy.

RESULTS:

A 3-month-old female after MVC presented with an ASIA-A SCI and a C5 motor level. Imaging revealed a C3-4 fracture-dislocation and right C3 pedicle fracture with cord transection at T1-2. The patient was placed in a c-collar until bony growth of the spine had occurred at 11 months-of-age. The patient then underwent stabilization and fusion as described above. Follow-up x-rays taken 8 months post-operatively revealed adequate bony growth and fusion.

CONCLUSION:

The literature on management of sub-axial SCIs in infants is sparse. Low bone density in this population limits surgical options for stabilization. We discuss a 3-month-old female with a C3-4 fracture-dislocation who underwent delayed posterior stabilization via sublaminar suturing at 11 months-of-age. The patient achieved successful bony fusion on follow-up imaging without evidence of non-union.
491 Usability and Acceptability of Clinical Decision Support for Children with Mild Traumatic Brain Injuries and Intracranial Injuries: A Mixed Methods Study
Authors: Greenberg Jacob K. , Otun Ayodamola , Carpenter Christopher , Brownson Ross , Kuppermann Nathan , Limbrick David D. , Foraker Randi , Yen Po-Yin
Published: March 2022

INTRODUCTION:

Electronic clinical decision support (CDS) may improve the safe, evidence-based management of children with mild traumatic brain injuries (mTBI) and intracranial injuries.

METHODS:

Emergency medicine and neurosurgery physicians were recruited to participate in study sessions to test the usability and acceptability of a novel CDS prototype in a simulated electronic health record environment. Testing sessions included interacting with the tool using three simulated clinical cases (https://head-injury-risk-predictor.web.app/case-1.htmlt), a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype was updated twice during testing (phases 1-3) to reflect user feedback. Usability problems were categorized and quantified using content analysis and reported with a descriptive summary. The semi-structured interviews were analyzed using thematic analysis.

RESULTS:

Twenty physicians (10 each from neurosurgery and emergency medicine) were recruited from nine separate hospitals. Most participants worked at teaching hospitals (80%) and level 1 trauma centers (75%). During the prototype updates, problems with clarity of terminology and wording were identified and corrected, along with problems navigating through and using the CDS interface. Corresponding to these changes, the number of usability problems dropped from 35 in phase 1 to 8 in phase 3, and the number of mistakes made went from 18 in phase 1 to 2 in phase 3. Through the survey, most participants found the tool easy to use (90%), useful for determining a patient’s level of care (95%), and likely to improve resource use (90%) and patient safety (79%). Major interview themes related to the CDS’s ability to support evidence-based decision-making and improve clinical workflow, proposed implementation strategies, and potential pitfalls to avoid.

CONCLUSION:

After the iterative evaluation and refinement, the elctronic CDS tool was found to be highly usable and useful for aiding the management of children with mTBI and intracranial injuries.
493 Increased Utilization of Healthcare Services in Children with Craniosynostosis
Authors: Colon Gabriela R. , Jin Michael C. , Grant Gerald A. , Prolo Laura M.
Published: March 2022

INTRODUCTION:

Craniosynostosis is a condition characterized by the premature fusion of at least one cranial suture. While evidence suggests that both syndromic and nonsyndromic patients may benefit from developmental, behavioral, and mental health support, data on utilization of healthcare services is lacking.

METHODS:

The Optum Clinformatics® DataMart database was queried to identify 1340 patients with craniosynostosis. Long-term utilization of mental health care, rehabilitation therapies, and other medical services up to age six was calculated. Rates of utilization were compared to healthy controls (n = 1577) and children with plagiocephaly (n = 1249).

RESULTS:

Mental health care was utilized more frequently in craniosynostosis patients (8.1%) compared to plagiocephaly (5.0%, p=0.0020) and healthy controls (2.9%, p<0.0001) . Physical, occupational and speech therapy were more frequently used by plagiocephaly than craniosynostosis patients (14.1% vs. 11.2%, p = 0.0283), which was significantly higher than use by controls (11.2% vs. 3.9%, p<0.0001). Other medical subspecialty services (developmental pediatrics, ophthalmology, optometry and audiology) were utilized by 37.0% of craniosynostosis patients, compared with 20.9% (p<0.0001) and 15.1% (p<0.0001) of plagiocephaly and healthy controls, respectively. Among craniosynostosis patients, utilization was not uniform by age; while ophthalmology utilization did not differ by age (p = 0.1003), mental health care was most commonly used among older children (p = 0.0107).

CONCLUSION:

In this study, we demonstrate that children with craniosynostosis utilize mental health care, rehabilitation therapies, and other medical subspecialty services at a higher rate than controls. While surgical correction may be considered an isolated event, these children should be monitored for developmental and mental health support longitudinally. Future work should explore risk factors driving utilization, including suture involvement, repair type, and comorbidities.
496 Stereotactic Electroencephalography is Associated with Reduced Opioid and NSAID Use When Compared to Subdural Grids: A Pediatric Case Series
Authors: Hunsaker Josh , Scoville Jonathan , Joyce Evan , Reese Jared C. , Wilde Herschel , Arain Amir , Bollo Robert J. , Rolston John D.
Published: March 2022

INTRODUCTION:

Opioid administration and consumption along with length of hospital stay can be decreased using minimally invasive surgery (MIS).

METHODS:

A retrospective chart review was conducted on pediatric patients that underwent surgery for epilepsy mapping using either SEEG or ECoG between 2015-2019. The hospital stay was divided into four distinct time periods and the total amount of opioids, NSAIDs, and pain scores were calculated for each time interval. The total amount of opioids were calculated by converting each type into their morphine equivalents (ME). Pain scores were calculated by using a modified version of the Clinically Aligned Pain Assessment (CAPA) scale. The two groups were then compared using appropriate statistical tests.

RESULTS:

The study included 40 patients including 31 in the SEEG group and 9 in the ECoG group. The SEEG group consumed significantly less opioids during the hospital stay when compared to the ECoG group (23.6 vs 61.7 MMEs; p=0.041). There were also significant differences in the length of stay (6.9 vs 12.2 days; p=0.002), complications (0% vs 20%; p=0.006), and total NSAIDs consumed (3264.8 vs 12730.2 mg; p=0.002).

CONCLUSION:

Opioid and NSAID consumption are significantly lower in pediatric patients who undergo epilepsy mapping via SEEG compared to ECoG. These patients also have a significantly shorter length of stay. MIS options should be considered by patients and physicians in order to decrease the overall use of pain medications and expedite patient discharge.
Υπερβολική χρήση του διαδικτύου, διαμόρφωση ταυτότητας του Εγώ, τύποι προσκόλλησης και υποκειμενική ευημερία στην αναδυόμενη ενηλικίωση
Authors: Καραμανώλη Ευαγγελία
Published: March 2022

Τις τελευταίες δύο δεκαετίες, η χρήση του διαδικτύου παρουσιάζει σημαντική αύξηση σε παγκόσμια κλίμακα. Οι συνέπειες της υπερβολικής χρήσης του αντανακλώνται σε προσωπικό, κοινωνικό, ακαδημαϊκό και επαγγελματικό επίπεδο. Σκοπός της παρούσας έρευνας είναι η μελέτη του φαινομένου σε αναδυόμενους ενήλικες καθώς, ως προς τις συνέπειες αυτές, προγενέστερες μελέτες αναφέρονται σε αυτή την ηλικιακή ομάδα ως «υψηλού κινδύνου». Οι διεργασίες διαμόρφωσης της ταυτότητας, οι τύποι προσκόλλησης και η υποκειμενική ευημερία εξετάζονται ως παράγοντες που σχετίζονται με την υπερβολική χρήση του διαδικτύου. Το δείγμα αποτέλεσαν 500 αναδυόμενοι ενήλικες, ηλικίας 18-25. Οι συμμετέχοντες συμπλήρωσαν: α) το Internet Addiction Test (Young, 1998a), β) το Dimensions of Identity Development Scale (Luyckx et al., 2008), γ) το Relationship Scales Questionnaire (Griffin & Bartholomew, 1994), δ) το Satisfaction with Life Scale (Diener et al.,1985), ε) ένα δημογραφικό ερωτηματολόγιο. Πενήντα εκ των συμμετεχόντων συμπλήρωναν για 12 μήνες το Scale of Positive and Negative Experience (Diener et al., 2009) για την αξιολόγηση του θετικού και αρνητικού συναισθήματος. Τα αποτελέσματα της έρευνας έδειξαν πως το ποσοστό της υπερβολικής χρήσης του διαδικτύου είναι σημαντικό στους αναδυόμενους ενήλικες και σχετίζεται με το φύλο (άνδρες > γυναίκες), τον χρόνο που περνούν τα άτομα στο διαδίκτυο και τις διαδικτυακές δραστηριότητες. Τα άτομα που δεν είναι ικανοποιημένα με τις παρούσες συνθήκες της ζωής τους, βρίσκονται σε μηρυκαστική διερεύνηση και αποφεύγουν τις στενές διαπροσωπικές σχέσεις, είναι πιθανό να καταφύγουν σε υπερβολική χρήση του διαδικτύου. Από το ημερολόγιο, διαπιστώθηκε πως η υπερβολική χρήση διαδικτύου σχετίζεται αρνητικά με το θετικό συναίσθημα, ενώ συμβάλλει σημαντικά και στη σταδιακή αύξηση του αρνητικού συναισθήματος. Τα συγκεκριμένα ευρήματα μπορούν να αποτελέσουν σημείο αναφοράς για την περαιτέρω διερεύνηση της χρήσης του διαδικτύου και της ποιότητας ζωής των νέων.
The genome sequence of the box-headed blood bee, Sphecodes monilicornis (Kirby, 1802)
Authors: Falk Steven ,   University of Oxford and Wytham Woods Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life programme,   Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective,   Tree of Life Core Informatics collective, Monks Joseph ,   Darwin Tree of Life Consortium
Published: March 2022

We present a genome assembly from an individual male Sphecodes monilicornis (the box-headed blood bee; Arthropoda; Insecta; Hymenoptera; Halictidae). The genome sequence is 497 megabases in span. The majority of the assembly (95.04%) is scaffolded into 19 chromosomal pseudomolecules. The mitochondrial genome was also assembled and is 15.6 kilobases in length.