bluuebunny/crossref_metadata_2025_split huggingface dataset:
258 Impact of Risk Stratified Antithrombotic Medication Resumption After Traumatic Brain Injury on Patient Outcomes
Authors: Kodvawala Raghad , Thomas Andrea , Yang George Liu , Cass Daryn Katherine , Gao Angela , Kruggel Andrew , Le Diana , Ngwenya Laura Benjamin 
Published: March 2024

INTRODUCTION:
The incidence of traumatic brain injury (TBI) in patients on antithrombotic (AT) medications to prevent thromboembolic events is increasing. AT medications include antiplatelets and/or anticoagulants. While these medications are generally stopped in the setting of intracranial bleed, the optimal medication resumption time is uncertain. Both brief and prolonged suspension carry risk. In March 2021 we adjusted our institutional guidelines from restarting AT therapy at two weeks or more after TBI to resuming medications based on patient risk factors.

METHODS:
We performed a retrospective case-control study of data from the University of Cincinnati Level 1 Trauma Center neurotrauma registry between February 2017-November 2022. Patients on AT therapy presenting with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13-15 were included. The LR cohort included patients from February 2017-December 2019. The RSR cohort included patients from March 2021-November 2022. Demographics, injury variables, medication history, medication resumption, and thrombotic or hemorrhagic events up to 6 months after injury were collected. Groups were compared using t-tests for linear variables and Chi-Square for categorical variables with p < 0.05 denoted as significant.

RESULTS:
We identified 406 patients with 337 patients in the LR cohort and 69 patients in the RSR cohort. Early resumption (during hospitalization) occurred in 21.7% of the RSR cohort compared to 9.5% in the LR group. The difference in occurrence of thrombotic and hemorrhagic events between groups was not significant.

CONCLUSIONS:
Resuming antithrombotic medications after a TBI based on risk stratification criteria allows earlier resumption of medication with no associated increase in thrombotic or hemorrhagic events.
259 Ultra-early (8 Hours) Surgery for Thoracic Spinal Cord Injuries: A Systematic Review and Meta-analysis
Authors: Bhimani Abhiraj D. , Carr Matthew Thomas , Al-Sharshahi Zahraa Fadhil , Hickman Zachary L. , Margetis Konstantinos D. 
Published: March 2024

INTRODUCTION:
The impact of the timing of surgery on neurological recovery in thoracic spinal cord injuries (tSCI) is still a subject of discussion. Accumulating evidence is supporting early decompression (<24 hours) following tSCI. However, the potential advantages of earlier decompression remain uncertain.

METHODS:
A search was conducted in the electronic databases Medline, Embase, Scopus, and Web of Science from their inception until May 2022 for human studies. Groups were stratified into ultra-early (surgery within 8 hours of injury) vs control group operated >8 hours of injury. The authors included the study data from their institutional case series of thoracolumbar spinal cord injury from 2015-2018. An arm-based meta-analysis was performed on all studies using the R Studio. For studies that qualified, a contrast-based meta-analysis was also performed with standardized mean difference (SMD). Outcomes were reported as effect size, treatment effect, and effect difference, all with 95% confidence intervals (CI).

RESULTS:
133 patients were included from 5 studies. 76 (57.1%) underwent decompression = 8 hrs, while 57 (42.9%) underwent decompression >8 hours from injury. Quantitative analysis using the SMD model showed a significant difference in mean AIS improvement in the ultra-early group [Effect size 1.15 (0.62-1.67), p < 0.0001]. On arm-based meta-analysis, a statistically significant treatment effect was found for ultra-early arm [1.25 (0.91-1.67)], while >8 hour arm did not show significance [0.30 (-0.08-0.71)]. There was a statistically significant effect difference between two arms [0.96(0.49-1.48)].

CONCLUSIONS:
This study observed a significant improvement in mean AIS score in patients undergoing decompression within 8 hours of tSCI. Given the scanty literature regarding ultra-early decompression of tSCI, this study solidifies the need to further explore the role of early interventions for tSCIs to improve patient outcomes.
263 Radiographic Structural Changes in Brain Anatomy of Pediatric Fetal Versus Postnatal Myelomeningocele Repair Patients
Authors: Desai Shivani , Woolard Alice , Guimaraes Carolina , Hung Sheng-Che , Quinsey Carolyn 
Published: March 2024

INTRODUCTION:
Postnatally repaired myelomeningocele (MMC) patients have twice the risk of needing shunt treatment for hydrocephalus compared to fetally repaired patients, however it is unknown why exactly this occurs as well as what structural brain changes may be predictive of hydrocephalus. We radiographically characterized anatomic changes in fetally vs postnatally treated infants to understand early developmental anatomy.

METHODS:
MRIs were characterized by two board-certified neuroradiologists for the following variables: 1) The ratio of ventricular-to-subarachnoid space (VSAR) using bifrontal (BF), left frontal lobe thickness (LV), and extra-axial (EA) spaces as parameters. 2) The ratio of 2 planes within the lateral ventricle (LVR). These ratios, elongation of the choroid plexus glomus and body, and Chiari were measured.

RESULTS:
54 MMC repair patients met criteria, yielding 109 MRIs. In the one-to-three month time frame, VSAR at BF and LV parameters in addition to LVR were all significantly different in the fetally repaired group (n = 14) compared to the postnatally repaired group (n = 13, p<0.05). VSAR was not significantly different in early life. Chiari was significantly different in the early life and one-to-three month time between fetal and postnatal repair cohorts (p < 0.05).

CONCLUSIONS:
Fetally and postnatally repaired MMC brain MRIs were examined by two neuroradiologists to characterize differences in early brain development. This study identified significant differences in the ventricular to subarachnoid space ratio during the one-to-three month time point between fetally and postnatally repaired patients. We suspect that subarachnoid anatomy may be predictive of the need for surgical treatment of hydrocephalus.
265 Inpatient Outcomes in Pediatric Patients With Non-accidental Versus Accidental Head Trauma: National Trauma Data Bank Analysis
Authors: Nosova Kristin , Kern Ashley , Deaver Courtney , Russell Rachel , Bauer Isabel L. , Pico Annie , Bates Bryan , He Jack , Keric Natasha , Nakaji Peter , Bina Robert Wagner 
Published: March 2024

INTRODUCTION:
Non-accidental trauma (NAT) is a leading cause of pediatric traumatic brain injury (TBI). Recent studies suggest NAT results in worse outcomes than accidental TBI, independent of severity of the injury and interventions.

METHODS:
Patients under 18 years old diagnosed with head trauma with or without NAT during 2019-2021 were identified in the NTDB. The predictor variables were demographics; previously validated prognostic factors , including motor score, verbal score, pupillary score, pupillary reactivity, image findings; neurosurgical interventions including EVD, ICPM, PbO2 monitoring; length of stay, and number of ventilated days. Data evaluation and univariate analysis were performed using summary statistics, t-tests, chi-square tests, and non-parametric tests. Mortality, length of ICU stay and complication rates were modeled using a multivariate logistic regression model. Outcomes were controlled for age, race, sex, and teaching vs nonteaching hospital.

RESULTS:
A total of 90,607 pediatric TBI events were identified in the database, 1721 (1.90%) cases with NAT. NAT was observed most often in 0-2 year-olds (64.78%), followed by 2-5 year-olds (22.66%), 6-10 and 15-18 year-olds (0.09% each), then 11-14 year-olds (0.07%). Patients with NAT had longer ICU stays (6.18 vs 4.93 days, p < 0.0001) and ventilator days, despite similar injury severity scores (p < 0.0001). In-hospital mortality was 30% more likely if NAT was the MOI (LR 1.3046, p < 0.001).

CONCLUSIONS:
Pediatric TBI patients with NAT have worse inpatient outcomes than similar patients with accidental injuries. Accurate diagnosis and better prognostication scales specific to patients with non-accidental trauma may lead to improved management and resource allocations for these sicker patients.
267 Risk Factors Associated With Baclofen Pump Infection in Children Translated Into Health-Care Costs: A Retrospective Analysis From the Children's Hospital of Pittsburgh Experience From 2009-2020
Authors: Fernandez-de Thomas Ricardo Jose , Huq Sakibul , Thambireddy Swetha , Adida Samuel , Kellogg Robert 
Published: March 2024

INTRODUCTION:
Intrathecal baclofen infusion is often used as a therapy for spasticity in children and adults, with pediatric cases more associated with infections. Infection leads to the need for pump explantation and is associated with a significantly increased hospitalization cost.

METHODS:
We retrospectively reviewed demographic, clinical, and economic data for children who underwent surgery for intrathecal baclofen pumps at a single institution from 2009-2020. Bivariable analyses (chi-squared tests) were conducted to compare differences in clinical characteristics between patients with surgical site infection and those without. Mann-Whitney tests were performed to compare total charges per patient between patients who had an infection versus those who did not.

RESULTS:
A total of 199 patients undergoing 442 surgeries were included. The cohort was 64% male and 84% Caucasian, with a mean age of 13.3 years. The most common indication for placement was cerebral palsy. Infection occurred in 28 patients (14% infection rate). The most common organisms were methicillin-resistant and methicillin-sensitive staph aureus. The pump model, access site, and the number of surgeons scrubbed were not associated with infection. Total hospital charges (for all surgeries) were significantly higher for patients with an infection versus those who did not ($231,762 vs. $187,028, p=0.0078), with an average charge increase of $44,734 associated with surgical site infection.

CONCLUSIONS:
In our single-center series, the most common indication for baclofen pump placement was cerebral palsy, with an infection rate of 14%, close to other rates reported in the literature. Total hospital charges were higher for patients with an associated surgical site infection than those without one.
271 A Retrospective, Chart Review Study of the Efficacy and Safety of the RNS System in Pediatric Populations for Medically Refractory Focal Epilepsy
Authors: Lin Christine , Kim-McManus Olivia , Sattar Shifteh , Rismanchi Neggy , Ravindra Vijay , Gonda David D. 
Published: March 2024

INTRODUCTION:
The Responsive Neurostimulation System (RNS) (NeuroPace, Mountain View) is a direct intracranial neurostimulator that is FDA-approved for adults with medically refractory focal epilepsy. There currently exists limited data regarding its efficacy and safety in pediatric populations.

METHODS:
A retrospective chart review was conducted of pediatric patients treated with the RNS System between January 1, 2019 and December 31, 2021 at Rady Children’s Hospital for at least one year. Data collected included percent change in median disabling seizure frequency from baseline at years 1, 2, and 3, as well as device-related serious adverse events.

RESULTS:
Twenty patients with medically refractory focal epilepsy were identified who had been treated with the RNS System for at least one year. Median duration of follow-up was 24 months (interquartile range [IQR]: 15-35 months) The median percent reduction in disabling seizures was 29% (N = 20, IQR = 0-84%) at 1 year, 53% (N = 12, IQR = -5-81%) at 2 years, and 67% (N = 4, IQR = 25-100%) at 3 years. 40% of patients reported a >90% reduction in median disabling seizure frequency, and 25% were seizure-free at last follow-up. Reductions in median seizure frequency were comparable based on patient age, age at seizure onset, neuroimaging findings, and prior intracranial monitoring. Zero patients experienced implant site infections. One patient (5%) required lead revision, and another patient (5%) had a spontaneous intraparenchymal hemorrhage at the generator site 2 years after implantation that resolved with expectant management. Neither of these events were associated with long-lasting neurological complications.

CONCLUSIONS:
The RNS System is a safe and efficacious treatment for pediatric patients with medically refractory focal epilepsy.
279 Does Surgical Treatment of Lumbar Spondylolisthesis Impact Self-care and Functional Independence? Five-Year Analysis of the Quality Outcomes Database
Authors: Le Vivian , DiDomenico Joseph D. , Johnson Sarah , Bisson Erica Fay , Bydon Mohamad , Kai-Hong Chan Andrew , Glassman Steven D. , Foley Kevin T. , Potts Eric A. , Shaffrey Christopher I. , Shaffrey Mark Edwin , Coric Domagoj , Wang Michael Y. , Knightly John J. , Park Paul , Fu Kai-Ming G. , Virk Michael S. , Slotkin Jonathan , Asher Anthony L. , Kerezoudis Panagiotis , Guan Jian , Michalopoulos Giorgos , Chou Dean , Haid Regis W. , Mummaneni Praveen V. , Uribe Juan S. , Turner Jay D. 
Published: March 2024

INTRODUCTION:
Lumbar spondylolisthesis may have an impact on patients’ ability to care for oneself and maintain functional independence. Surgical treatment is associated with improvement in patient function but the impact on self-care is not well understood.

METHODS:
This is a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients with surgically treated grade I lumbar spondylolisthesis with five years of follow-up were included. Patient reported outcomes (PROs) were recorded. Patients were grouped into baseline dependent or independent cohorts based on the Personal Care component of the ODI (0-2=independent; ³3=dependent). Minimum clinically important difference (MCID) was defined as a 30% reduction from baseline disability.

RESULTS:
Of the 602 patients, 535 (89%) were independent and 67 (11%) were dependent at baseline with mean age of 63 and 59, respectively (p = 0.01). 479 patients (80%) reported 60-month follow up Personal Care scores, with 59% reporting improvement and 41% having worse or no improvement. At 60-month follow-up, 87.5% of dependent patients had gained lasting independence. Dependent and independent cohorts met 5-year MCIDs at similar rates. Baseline dependence was universally associated with worse pre-operative PROs (p < 0.01). 60-month improvement in personal care was associated with greater satisfaction and rates of MCID for all PROs (p < 0.01). 60-month improvement in personal care was positively associated with surgical treatment including arthrodesis versus motion-preserving surgery (OR = 1.17, 95%CI 1.04-1.32, p = 0.01).

CONCLUSIONS:
Dependent patients with lumbar spondylolisthesis achieve very high rates of independence (87.5%) which is durable through 5 years of follow-up. The dependent cohort represented only 11% of the cohort and was significantly younger at baseline. Spondylolisthesis patients treated with arthrodesis are more likely to improve their long-term self-care and independence.
280 Are We Getting Better at Treating Adult Cervical Deformity? Complication Rate Trends Analysis in Adult Cervical Deformity Over 10 Years
Authors: Mir Jamshaid M. , Dave Pooja , Tretiakov Peter S. , Das Ankita , Kurland David B. , Robertson Djani , Janjua Burhan , Jankowski Patrick Patryk , Passias Peter G. 
Published: March 2024

INTRODUCTION:
Adult cervical deformity patients can have significant impact on quality of life. Realignment surgery has proven to be effective in a select group of these patients, however despite advancements in the field, complications are not uncommon. Evaluation of outcomes overtime can be insightful on aspects that surgeons have been improving on and those that remain to be a nuance.

METHODS:
Adult Cervical Deformity(ACD) patients with a minimum 2-year follow-up and less than 10 levels fused were included. Patients were stratified into quartiles by date of surgery, with the middle two quartiles being merged to form three categories: Early(E), Middle(M), Recent(R). ANCOVA was used to assess complication rates and PROMs amongst tertiles controlling for age, gender, osteoporosis, CCI, mFI, TS-CL, cSVA, and levels fused. Multivariate analyses were used to assess differences in surgical, radiographic, and clinical outcomes over time.

RESULTS:
570 patients were included. Age, CCI, and mFI were highest in R cohort. No difference at baseline in Ames modifiers amongst cohorts. Controlled analysis depicted lowest rates of complications in R (E: 62.5%, M: 72.7%, R: 45.5%). Major complication rates decreased from 59.8% in E to 15.0% in last cohort. Rates of DJK decreased from M to R (39.6% to 12.7%, p = .011), with rate of DJF being lowest in R and highest in M (20% in M, 12% in E, 6.7% in R, p = 0.046). Reoperation rates decreased from 18.8% in E to 12.4% in R. Neurological complications decreased as well from 38.5% in E to 2.1% in R (p = 0.044). Cardiopulmonary complication rates decreased from 24.8% in M to 3.5% in R.

CONCLUSIONS:
Complication rates decreased over a 10 year period amongst cases, despite having higher age, frailty, comorbidities, mJOA, and no difference in baseline deformity between early and recent cases.
281 Does Smoking Status Affect Achievement of Satisfaction and Minimum Clinically Important Difference in Outcomes in Patients With Cervical Myelopathy at 24 Months? A QOD Study
Authors: Park Christine , Shaffrey Christopher I. , Johnson Sarah , Bisson Erica Fay , Sherrod Brandon , Asher Anthony L. , Coric Domagoj , Potts Eric A. , Foley Kevin T. , Wang Michael Y. , Fu Kai-Ming G. , Virk Michael S. , Knightly John J. , Meyer Scott A. , Park Paul , Upadhyaya Cheerag D. , Shaffrey Mark Edwin , Lee Buchholz Avery , Tumialan Luis Manuel , Turner Jay D. , Agarwal Nitin , Chan Andrew , Chou Dean , Haid Regis W. , Mummaneni Praveen V. , Michalopoulos Giorgos , Bydon Mohamad , Gottfried Oren N. 
Published: March 2024

INTRODUCTION:
It is not clear whether smoking impacts patient-reported outcomes (PROs) in patients with cervical spondylotic myelopathy (CSM).

METHODS:
This was an analysis of the prospective Quality Outcomes Database CSM module. Patients of age = 18 years diagnosed with primary CSM who underwent elective surgery were included. PROs (VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction) were collected at baseline and 24 months.

RESULTS:
Of the 1,141 patients with CSM, 202 (17.7%) were smokers and 939 (82.3%) were non-smokers. Compared to the non-smokers, smokers were younger (56.3 ± 11.3 vs 61.5 ± 11.7, p<0.01) and had lower BMI (29.3 ± 6.8 vs 30.3 ± 6.3, p=0.04). A higher number of smokers had depression, anxiety, and COPD (all p<0.01). At baseline, smokers had worse pain (neck: 6.0 ± 3.2 vs 5.1 ± 3.3; arm: 5.7 ± 3.2 vs 4.7 ± 3.5), disability (NDI: 45.2 ± 20.0 vs 37.1 ± 20.6), myelopathy (mJOA: 11.5 ± 2.9 vs 12.2 ± 2.8), and quality of life (EQ-5D: 0.51 ± 0.23 vs 0.57 ± 0.22) (all p < 0.01). At 24-month follow-up, a higher proportion of smokers achieved MCID in mJOA (69.4% vs 56.6%, p < 0.01) compared to non-smokers. Otherwise, there was no significant difference in the PROs at 24-month follow-up between the two groups (all p > 0.05). The two groups were also similarly satisfied (NASS 1-2: smoker 81.2% vs non-smoker 84.6%, p = 0.29) 24 months after surgery.

CONCLUSIONS:
Despite smokers having worse baseline characteristics in terms of comorbidities and outcomes of interest, both smokers and non-smokers experienced improvement in all the PROs and achieved similar rates of MCID and satisfaction. Although smoking continues to be an important risk factor for poor surgical outcome, it may not have significant impact on PROs and satisfaction in this patient population.
292 Intraoperative Confocal Laser Endomicroscopy During 5-ALA Guided Glioma Surgery: Significant Considerations for Resection at the Tumor Margins
Authors: Abramov Irakliy , Xu Yuan , Mignucci-Jiménez Giancarlo , Hartke Joelle Nicole , Belykh Evgenii , Porter Randall , Sanai Nader , Smith Kris A. , Eschbacher Jennifer , Preul Mark C. 
Published: March 2024

INTRODUCTION:
Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has proven effective in aiding the detection of glioma marginal zones and enhancing maximal safe resection. FDA-cleared confocal laser endomicroscopy is another imaging modality for intraoperative brain tissue discrimination on cellular level that could improve visualization at the glioma margin.

METHODS:
5-ALA wide-field imaging and CLE were used in 9 patients with gliomas (6 enhancing, 3 non-enhancing). CLE imaging was enhanced by the use of a telesurgical pathology software platform to enable real-time conversation between neurosurgeons and pathologists located remotely. CLE was used for imaging tumor regions subjectively regarded as tumor margins under normal visualization with the operative microscope. After CLE imaging, 5-ALA wide-field imaging was performed in the same regions. A tissue was harvested at imaging locations, and interpretations of CLE and 5-ALA wide-field imaging were compared to permanent histological sections.

RESULTS:
Overall, 20 deep and superficial margin regions of interest (ROI) were imaged with CLE and 5-ALA imaging. Most of the ROIs interpreted by the neuropathologist as infiltrative glioma based on CLE imaging lacked 5-ALA-induced fluorescence. Permanent histological sections from the corresponding regions were concordant with the interpretation of CLE images in 15 of 20 (75%) ROIs and with the interpretation of 5-ALA imaging in 11 of 20 (55%) ROIs. Sensitivity/specificity of CLE and 5-ALA for interpretation of tumor margins were 79%/67%, and 50%/67%, respectively. Positive/negative predictive values for CLE and 5-ALA were 85%/57%, and 78%/37%, respectively.

CONCLUSIONS:
Conventional intraoperative understanding of tumor margins based on wide-field fluorescence could underestimate the invasiveness of gliomas. The ongoing study demonstrates that CLE shows higher accuracy in detecting regions with infiltrating tumor than intraoperative 5-ALA imaging.