Eirik Helseth

• Rydning, pål Nicolay; Linnerud, Hege; MIRZAMOHAMMADI, JALAL; Brommeland, Tor; Mejlænder-Evjensvold, Magnus & Stenset, Vidar [Show all 9 contributors for this article] (2026). Subaxial cervical spine fractures in ankylosing spondylitis: management and outcomes from a 10-year population-based cohort. Journal of Neurosurgery : Spine. ISSN 1547-5654. 45(3), p. 347–356. doi: 10.3171/2026.1.SPINE251637. Full text in Research Archive
• Aarhus, Mads; Netteland, Dag Ferner; Tverdal, Cathrine Buaas; Stenset, Vidar; Rønning, Pål Andre & Helseth, Eirik (2026). CT-positive traumatic brain injury in patients ≥ 80 years: mortality and 6-months functional outcome. Acta Neurochirurgica. ISSN 0001-6268. 168. doi: 10.1007/s00701-026-06964-7. Full text in Research Archive Show summary

  Purpose Traumatic brain injury (TBI) in patients ≥ 80 years poses major clinical challenges, with limited evidence to guide neurosurgical decision-making. We evaluated mortality, functional outcomes, and prognostic factors in patients undergoing neurosurgical versus conservative management. Methods This cohort study included patients ≥ 80 years with imaging-verified TBI treated at a tertiary trauma centre. Demographics, injury characteristics, treatment, mortality, and 6-month outcomes were collected. Favourable outcome was defined as Glasgow Outcome Scale 4 and 5. Multivariable logistic regression identified predictors of mortality and unfavourable outcome, and Cox regression assessed 30, 180, and 365 days mortality. Results A total of 608 patients (median age 85.8 years; 52% female) were included; 84 (14%) underwent neurosurgical intervention. Thirty-day and one-year mortality were 24% and 42%, respectively. Neurosurgical intervention was associated with reduced 30-day mortality (HR 0.46, 95% CI 0.28–0.76; p = 0.002) but not one-year mortality (HR 0.84, 95% CI 0.63–1.12; p = 0.23). Favourable 6-month outcome occurred in 29% of patients having intervention versus 34% of conservatively managed patients (p = 0.439). Increasing age, higher ASA class, dependent preinjury living, and injury severity were independently associated with unfavourable outcome. Acute craniotomy was associated with higher mortality and unfavourable outcome, whereas later trephination for subsequent chronic subdural haematoma was associated with lower mortality (5%) and better outcomes. Guideline adherence for ICP monitoring was 54%. Conclusion In patients ≥ 80 years with TBI, neurosurgical intervention was associated with reduced early mortality but was not associated with improved 365-days survival or functional outcome at 6 months. Outcomes were largely determined by preinjury status and injury severity. These findings suggest selective surgical decision-making, with consideration of baseline function, comorbidity, and patient-centred goals of care.

• Aarhus, Mads; Netteland, Dag Ferner; Tverdal, Cathrine Buaas; Stenset, Vidar; Rønning, Pål Andre & Helseth, Eirik (2026). Civilian penetrating traumatic brain injury in South-East Norway. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 34(1). doi: 10.1186/s13049-026-01623-3. Full text in Research Archive Show summary

  Background Civilian penetrating traumatic brain injury (cpTBI) is a rare entity associated with severe and often devastating consequences. Guidelines recommend CT angiography (CTA), prophylactic antibiotics (AB) and antiseizure medication (ASM), early surgical revision with dural closure whenever feasible, and intracranial pressure (ICP)-guided therapy. The study aimed to investigate guideline compliance, as well as outcome after cpTBI for patients admitted to Oslo University Hospital (OUH). Methods We identified and included cpTBI patients admitted to OUH between 2015 and 2023 through the Oslo TBI Registry – Neurosurgery. Guideline adherence was assessed and variables associated with 30-day mortality and Glasgow Outcome Scale (GOS) were examined using standard uni- and multivariable techniques. Results The incidence of cpTBI was 1.9/1.000.000 with a 30-day mortality rate of 42.3%. Among the survivors, 70% achieved a favourable outcome (GOS 4 and 5) at 6 months. CTA was obtained at an acceptable rate (81%) in concordance with guidelines, but the guideline compliance for AB (12%) and ASM (29%) was substantially lower-than-expected. Surgery started within 12 h after injury in 58%, and ICP was monitored in 53.5% of patients with GCS < 9. Conclusions Despite high mortality in cpTBI, most survivors achieved favourable outcome. We found a lower-than-expected guideline compliance for prophylactic AB and ASM, ICP monitoring, and surgical revision within 12 h. Thus, we identified several key factors that can improve cpTBI treatment at our institution. For patients considered potential survivors, management should be aggressive and aligned with established TBI treatment principles, including early vascular imaging with CTA, prompt wound debridement with dural closure, and prophylactic administration of AB and ASM.

• Mireles, Eduardo Erasmo Mendoza; Blakstad, Hanne Kristin; Server, Andres Alonso; Leske, Henning; Skaga, Erlend & Aarhus, Mads [Show all 11 contributors for this article] (2026). Extent of resection and perioperative neurological status as prognostic markers in glioblastoma: a population-based study. Journal of Neuro-Oncology. ISSN 0167-594X. 177(1). doi: 10.1007/s11060-026-05481-y. Full text in Research Archive Show summary

  Purpose Maximal safe resection is the suggested standard for surgical treatment for patients with IDH-wildtype glioblastoma. Surgical safety is prioritized over radical extent of resection (EOR) because new neurological deficits are considered detrimental for survival. The aim of this study was to explore the combined impact of extent of resection and neurological status on survival in glioblastoma patients, using standardized tools for neurological function (neurological assessment in neuro-oncology (NANO scale) and extent of resection (RANO resect classification). Methods Population-based study of all adult patients who underwent resection for newly diagnosed glioblastoma from 2019 to 2022 in a geographically defined region. EOR was evaluated according to the RANO resect classification. Neurological function was assessed using the NANO scale preoperatively, immediately after surgery, and before start of radiotherapy. Kaplan Meier survival analysis, chi-square and log-rank tests were used to compare groups. Results The median overall survival (mOS) for 503 patients was 12.9 months. RANO resect class 1 was associated with significantly longer mOS compared to patients with RANO classes 2, 3, and 4 (21.0 vs. 14.8, 8.3, and 4.5 months, respectively; p < 0.01). Preoperatively neurologically intact patients (NANO-score 0) had a longer mOS, than patients with neurological deficits. Neither the postoperative NANO-score nor the change in the score impacted survival. Conclusions Being neurologically intact before surgery and supramaximal resection were independent, strong predictors of longer survival. Mild to moderate new postoperative neurological deficits did not impact mOS, suggesting that supramaximal resection may confer a survival benefit even when such deficits are induced.

• MIRZAMOHAMMADI, JALAL; Austad, Tor Arnøy; Stenset, Vidar; Biernat, Donata; Aarhus, Mads & Helseth, Eirik [Show all 7 contributors for this article] (2026). Accuracy and safety of navigated pedicle screw insertion in cervical spine fractures. Frontiers in Surgery. 13. doi: 10.3389/fsurg.2026.1773142. Full text in Research Archive
• Vreeburg, Rick J.G.; Singh, Ranjit D.; Yue, John K.; Dijck, Jeroen T.J.M. van; Boogert, Hugo F. den & Posti, Jussi P. [Show all 262 contributors for this article] (2026). The effectiveness of decompressive craniectomy size in traumatic brain injury; an international, observational, comparative effectiveness study. Brain and Spine. 6. doi: 10.1016/j.bas.2026.106019. Full text in Research Archive Show summary

  Introduction Guidelines recommend large decompressive craniectomies (DC) in traumatic brain injury (TBI), yet the optimal size remains debated. Real-world practice often differs from guideline recommendations and generalizability of prior evidence to a broader TBI population is uncertain. Research question What is the comparative effectiveness of DC size on 12-month functional outcome in TBI? Material and methods We selected participants enrolled in the CENTER-TBI diagnosed with TBI who received a hemicraniectomy. Effect of DC size on functional outcome was evaluated with random-effects logistic regression, associating center case-mix adjusted DC sizes to GOSE. Center preference was quantified with the median odds ratio (MOR). Results Among 4509 patients enrolled in CENTER-TBI, 295 underwent a hemicraniectomy. DC size varied from 37 cm2 to 165cm2 (IQR 96 cm2-123cm2, ellipsoid calculation), with a two-times higher probability of receiving a 27 cm2 larger (IQR increase) DC for a similar patient in one center versus another random center (adjusted MOR for DC size 1·7). Only 4 patients received a DC ≥ 12 × 15 cm (cm) or 15 cm in diameter, while 0 patients received a DC ≤ 6 × 8 cm. Larger DC size was not associated with more favorable 12-month GOSE scores (aOR 0.73 for 27 cm2 increase in DC size, 95%CI 0.47-1.1). Discussion and conclusion DC size varied widely across European centers. Recommended DC sizes were rarely reached, as were very small DC sizes. Larger versus smaller DC was associated with similar outcomes, however heterogeneity in DC indication may have attenuated observable treatment effects. Neurosurgeons may continue to prefer larger over smaller decompressions.

• Graziano, Francesca; Guglielmi, Angelo; Consonni, Michela; Ogliari, Giorgia; Younsi, Alexander & Valla, Margherita [Show all 259 contributors for this article] (2026). Paediatric traumatic brain injury: clinical presentation, treatment approaches, management strategies, and outcomes. Insights from the CENTER-TBI study. Journal of Anesthesia, Analgesia and Critical Care. 6. doi: 10.1186/s44158-025-00312-4. Full text in Research Archive Show summary

  Objective: This observational study aims to describe the characteristics and management of paediatric head-injured patients across different paediatric age groups, compared with adults. Design: Secondary analysis of the CENTER-TBI study. Setting: 65 centers in Europe between December 2014 and December 2017. Patients: Patients with traumatic brain injury (TBI) admitted to the hospital were divided into different age groups: paediatrics (pTBI, age ≤ 17 years), adults (18-65 years), and elderly (> 65 years). Paediatrics were further subdivided into three groups: toddlers (from 0 to 4 years), children (from 5 to 12 years), and adolescents (from 13 to 17 years). Interventions: None. Measurements and main results: 3,661 patients were included in the analysis (2,138 admitted to the intensive care unit (ICU) and 1,523 to the ward). Among these, 227 were paediatric (27 toddlers [0-4 years], 65 children [5-12 years], and 135 adolescents [13-17 years]). Most pTBI patients admitted to the ICU presented with mild injuries (Glasgow Coma Scale [GCS] 13-15; 66%), although severe injuries (GCS ≤ 8) were more common in adolescents (23.8%). Susceptibility to neuroworsening and seizures was low in the paediatric group (6% and 3.5%, respectively). Intracranial pressure monitoring was performed in 52 (39.4%) of 132 paediatric ICU patients. Paediatric patients received less intensive therapy targeted to the intracranial pressure (ICP) control particularly in toddlers. Age below 18 years was associated with a lower risk of poor neurological outcomes at six months, particularly in adolescents and children (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.15-0.58 p < 0.001 and OR = 0.29, 95% CI = 0.09-0.71, p < 0.001, respectively). In toddlers, the association was not statistically significant (OR = 0.48, 95% CI = 0.07-1.94, p = 0.4). Conclusions: Paediatric TBI differs significantly from non-paediatric cases, with predominantly mild injuries, lower neuroworsening rates, and less intensive management, especially in younger children. Outcomes at six months are generally more favorable in paediatric patients, emphasizing the need for age-specific management strategies in TBI care.

• Strøm, Mona; MIRZAMOHAMMADI, JALAL; Glott, Thomas; Brommeland, Tor; Linnerud, Hege & Rønning, Pål Andre [Show all 12 contributors for this article] (2025). Epidemiology of Traumatic Cervical Spinal Cord Injury in Southeast Norway. Neurotrauma Reports. 6(1), p. 539–550. doi: 10.1089/neur.2025.0013. Full text in Research Archive
• Sødal, Hild Flatmark; Balosso, Silvia; Vezzani, Annamaria; Pasetto, Laura; Bonetto, Valentina & Columbro, Stefano Fabrizio [Show all 10 contributors for this article] (2025). Inflammatory proteins as acute biomarkers of post-traumatic epilepsy. Frontiers in Neurology. 16. doi: 10.3389/fneur.2025.1720112. Full text in Research Archive
• Tverdal, Cathrine Buaas; Reiner, Andrew Henry; Helseth, Eirik; Hellstrøm, Torgeir; Manskow, Unn Sollid & Aarhus, Mads [Show all 9 contributors for this article] (2025). Comparison of traumatic brain injury resulting from stair-related falls to falls from standing height—a neurotrauma center cohort. Frontiers in Neurology. 16. doi: 10.3389/fneur.2025.1599229. Full text in Research Archive Show summary

  Background: Falls are the leading cause of traumatic brain injury (TBI) in high-income countries, and globally, the incidence of fall-reBackground: Falls are the leading cause of traumatic brain injury (TBI) in high-income countries, and globally, the incidence of fall-related injuries is projected to rise. In this study, we compare TBI resulting from stair-related falls (SRFs) to falls from standing height (FSH), analyzing their epidemiology and outcomes. Methods: In a single-center, registry-based cohort study using the Oslo TBI Registry-Neurosurgery (OTBIR-N), we identified adults (≥18 years) admitted to Oslo University Hospital with TBI from either SRFs or FSH between 2015 and 2022. Epidemiology and outcome measures were compared between the two groups, and a multivariate logistic regression model was used to evaluate the adjusted effect of the fall mechanisms on dichotomized functional outcome (Glasgow outcome score (GOS) 1–3 vs. GOS 4–5). Results: A total of 1,432 patients with a median age of 71 years were included. SRFs represented 25%, while FSH represented 52% of all fall-related TBIs. SRF patients were generally younger and healthier, with a higher frequency of moderate to severe TBI than FSH patients (53% vs. 31%; p < 0.001). SRFs also occurred more often during evenings and nights, on weekends, and were more often related to alcohol influence (58% vs. 22%; p < 0.001). Both fall types resulted in unfavorable functional outcomes (GOS 1–3) for a substantial proportion of patients (37% in SRFs and 42% in FSH; p = 0.066). When adjusting for covariates in the multivariable logistic regression model, there was a tendency of SRFs being associated with unfavorable outcomes compared to FSH, but the effect was not statistically significant (OR 1.43, 95%CI 0.97–2.12; p = 0.073). Conclusion: SRFs represented a considerable proportion of fall-related TBIs and were associated with poor outcomes in a substantial proportion of patients. Targeted public awareness campaigns addressing the risks associated with staircases, especially when combined with alcohol influence, seem warranted to prevent such injuries.

• Netteland, Dag Ferner; Rønning, Pål Andre; Brommeland, Tor; Stenset, Vidar; Tverdal, Cathrine Buaas & Aarhus, Mads [Show all 7 contributors for this article] (2025). Age and Time as Predictors of Outcome in Patients Undergoing Decompressive Craniectomy for Traumatic Brain Injury. World Neurosurgery. ISSN 1878-8750. 203. doi: 10.1016/j.wneu.2025.124471. Full text in Research Archive
• Ramm-Pettersen, Nora Marie; Ramm-Pettersen, Jon; Helseth, Eirik; Skogen, Karoline & Aarhus, Mads (2025). The Transciliary Supraorbital Keyhole Approach for Different Intracranial Pathologies: Lessons Learned After the Implementation of a New Surgical Technique in a General Neurosurgical Department. World Neurosurgery. ISSN 1878-8750. 205. doi: 10.1016/j.wneu.2025.124704. Full text in Research Archive
• Mikolić, Ana; Klaveren, David van; Jost, Mathilde; Maas, Andrew IR; Shi, Shuyuan & Silverberg, Noah D [Show all 246 contributors for this article] (2025). Prognostic models for depression and post-traumatic stress disorder symptoms following traumatic brain injury: a CENTER-TBI study. BMJ Mental Health. 28(1). doi: 10.1136/bmjment-2024-301181. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is associated with an increased risk of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). We aimed to identify predictors and develop models for the prediction of depression and PTSD symptoms at 6 months post-TBI. Methods We analysed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. We used linear regression to model the relationship between predictors and depression (Patient Health Questionnaire-9) and PTSD symptoms (PTSD Checklist for Diagnostic and Statistical Manual for Mental Health Disorders Fifth Edition). Predictors were selected based on Akaike’s Information Criterion. Additionally, we fitted logistic models for the endpoints ‘probable MDD’ and ‘probable PTSD’. We also examined the incremental prognostic value of 2–3 weeks of symptoms. Results We included 2163 adults (76% Glasgow Coma Scale=13–15). Depending on the scoring criteria, 7–18% screened positive for probable MDD and about 10% for probable PTSD. For both outcomes, the selected models included psychiatric history, employment status, sex, injury cause, alcohol intoxication and total injury severity; and for depression symptoms also preinjury health and education. The performance of the models was modest (proportion of explained variance=R2 8% and 7% for depression and PTSD, respectively). Symptoms assessed at 2–3 weeks had a large incremental prognostic value (delta R2=0.25, 95% CI 0.24 to 0.26 for depression symptoms; delta R2=0.30, 95% CI 0.29 to 0.31 for PTSD). Conclusion Preinjury characteristics, such as psychiatric history and unemployment, and injury characteristics, such as violent injury cause, can increase the risk of mental health problems after TBI. The identification of patients at risk should be guided by early screening of mental health.

• Nelson, Lindsay D.; Magnus, Brooke E.; Yue, John K.; Balsis, Steve; Patrick, Christopher J. & Temkin, Nancy [Show all 272 contributors for this article] (2025). Beyond mild, moderate, and severe traumatic brain injury: modelling severity from clinical, neuroimaging, and blood-based indicators. EBioMedicine. 121. doi: 10.1016/j.ebiom.2025.106001. Full text in Research Archive Show summary

  Background: The conventional clinical approach to characterising traumatic brain injuries (TBIs) as mild, moderate, or severe using the Glasgow Coma Scale (GCS) total score has well-known limitations, prompting calls for more sophisticated strategies. Methods: We used item response theory (IRT) to develop a new method for quantifying TBI severity using 24 clinical, head computed tomography, and blood-based biomarker variables familiar to clinicians and researchers. IRT uses individuals' response patterns across indicators to estimate relationships between the indicators and a latent continuum of TBI severity. Model parameters were used to assign severity scores in two large cohorts, and associations with traditional GCS categories and 6-month functional outcomes (Glasgow Outcome Scale-Extended [GOSE]) were tested with correlational and logistic regression analyses. Findings: In the prospective Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort (N = 2545), modelling showed the 24 indicators index a common latent continuum of TBI severity. IRT enabled us to identify the relative contribution of these features to estimate an individual's TBI severity. Finally, within both the TRACK-TBI derivation sample and an external validation sample (Collaborative European NeuroTrauma Effectiveness Research in TBI [CENTER-TBI]), TBI severity scores generated using this novel IRT-based method incrementally predicted functional (GOSE) outcome better than classic clinical (mild, moderate, severe) or International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) classification methods. Interpretation: Our findings directly inform ongoing international efforts to refine and deploy new pragmatic, empirically-supported strategies for characterising TBI, while illustrating a strategy that may be useful to improve staging systems for other diseases.

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Soberg, Helene Lundgaard & Røise, Olav [Show all 15 contributors for this article] (2025). Early Injury-Related Predictors of Disability 6 Months After Moderate to Severe Trauma: A Longitudinal Study. Disabilities. 5(3). doi: 10.3390/disabilities5030073. Full text in Research Archive Show summary

  Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs.

• Biernat, Donata; Bugge, Robin Antony Birkeland; Ramm-Pettersen, Jon-Terje; SCHELLHORN, TILL; Rønning, Pål Andre & Helseth, Eirik [Show all 8 contributors for this article] (2025). Predicting intraoperative meningioma consistency using features from standard MRI sequences: a preoperative evaluation. Acta Neurochirurgica. ISSN 0001-6268. 167(1). doi: 10.1007/s00701-025-06582-9. Full text in Research Archive Show summary

  Abstract Background Symptomatic meningiomas may require surgical resection to save or improve neurological function. The extent of tumor resection depends on multiple factors, including the tumor's consistency, its location, and the patient's overall condition. This prospective study aims to explore new criteria in combination with previously proposed tumor features on MRI to establish a rapid approach to tumor consistency characterization pre-operatively. Methods Forty-eight patients with meningiomas were prospectively included and underwent a dedicated MRI protocol prior to surgery. Qualitative and quantitative MRI characteristics of the tumor were correlated to a previously proposed surgical tumor consistency grading. Results Soft tumors were associated with homogeneous contrast enhancement, high T2 signal, absence of peritumoral edema (PTE), the presence of tumor cysts, and a uniformly dark appearance on fractional anisotropy (FA) maps. In contrast, firmer tumors were characterized by heterogeneous contrast enhancement, low T2 signal, the presence of PTE, absence of tumor cysts and a heterogeneous appearance on FA maps, requiring supranormal ultrasonic aspirator settings. Tumor signal quantification on T2 and Apparent Diffusion Coefficient maps (ADC) correlated moderately to tumor consistency. T1 sequences did not contribute in determining tumor consistency. Conclusion An array of simple qualitative meningioma characteristics on MRI can assist in swift discrimination of soft and hard tumors preoperatively. These have been displayed in a figure that can easily be implemented clinically for optimal surgical planning.

• Bhattacharyay, Shubhayu; Leeuwen, Florian D. van; Beqiri, Erta; Åkerlund, Cecilia A. I.; Wilson, Lindsay & Steyerberg, Ewout W. [Show all 257 contributors for this article] (2025). TILTomorrow today: dynamic factors predicting changes in intracranial pressure treatment intensity after traumatic brain injury. Scientific Reports. 15(1). doi: 10.1038/s41598-024-83862-x. Full text in Research Archive
• Rizvi, Syed Ali Mujtaba; Linnerud, Hege; Rønning, Pål Andre; Brommeland, Tor; Aarhus, Mads & MIRZAMOHAMMADI, JALAL [Show all 10 contributors for this article] (2025). Traumatic odontoid fracture – Proposal of a treatment algorithm. Clinical neurology and neurosurgery (Dutch-Flemish ed. Print). ISSN 0303-8467. 254. doi: 10.1016/j.clineuro.2025.108951. Full text in Research Archive
• Cuevas-Østrem, Mathias; Wisborg, Torben; Røise, Olav; Helseth, Eirik & Jeppesen, Elisabeth (2025). Decision-making in interhospital transfer of traumatic brain injury patients: exploring the perspectives of surgeons at general hospitals and neurosurgeons at neurotrauma centres. BMC Health Services Research. 25(1). doi: 10.1186/s12913-024-11968-z. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is a significant public health concern. Advancing age and comorbidities are associated with a reduced probability of being transferred to neurotrauma centres (NTCs) from non-neurosurgical acute care trauma hospitals (ACTHs). However, the extent to which these decisions reflect well-considered treatment-limiting decisions and which influence other factors have on the decision-making process remains unclear. Objective To increase the understanding of adults’ access to NTC care by exploring the decision-making process for interhospital transfer of patients with isolated TBI, elucidating factors influencing these decisions. Methods Fifteen surgeons and neurosurgeons from four hospitals in Norway were recruited through purposive sampling to four semi-structured focus group interviews. Surgeons represented ACTHs and neurosurgeons NTCs, and all participants were responsible for TBI patients' initial care and transfer decisions. Interviews were thematically analysed. Results We identified several factors influencing transfer decisions, captured in six main themes under one overarching theme; ‘The chance of a favourable outcome’. The six main themes reflect surgeons’ and neurosurgeons’ decision-making process, which included clinical and system-level factors: (A) ‘Establish TBI severity: Glasgow Coma Scale score and head CT’, (B) ‘Preinjury health status: comorbidity, functioning, and age’, (C) ‘Distance from ACTH to NTC: distance is time and time is brain’, (D) ‘Uncertainty and insecurity’, (E) ‘Capacity at NTC’, and (F) ‘Next of kin involvement’. Conclusion On-call surgeons and neurosurgeons responsible for making transfer decisions for TBI patients emphasise the importance of patient-centred decisions, including individual patients’ risk factors and overall health status.

• Døving, Mats; Galteland, Pål; Næss, Ingar; Sehic, Amer; Dalby, Marius & Utheim, Tor Paaske [Show all 10 contributors for this article] (2025). Craniofacial Soft Tissue Injuries: An Observational Study of Bicycling Injuries from a Level 1 Trauma Center. The Journal of craniofacial surgery (Print). ISSN 1049-2275. 36(8), p. 2696–2700. doi: 10.1097/SCS.0000000000011409. Full text in Research Archive Show summary

  Craniofacial injuries in bicycling accidents are common, yet limited information exists on associated soft tissue injuries. This study aims to investigate the prevalence and anatomic patterns of such injuries, and their association with helmet use and craniofacial fractures. The study included 1543 patients with bicycle injuries from a level 1 trauma center. Retrospective chart review was conducted for patients with craniofacial soft tissue injuries. Craniofacial soft tissue injuries were identified in 646 cyclists (41.9%). Odds of injury increased with years of age [aOR 1.02 (1.01–1.02), P<0.001], and women were at a higher risk compared with men [aOR 1.35 (1.05–1.75), P=0.02]. Injuries were distributed across the scalp (19%), upper third (56%), midface (69%), and lower third (32%) of the face. Helmets were used by 38% of the patients with soft tissue injuries. Helmet use reduced the odds of craniofacial soft tissue injuries overall [aOR 0.49 (0.39–0.62), P<0.001], scalp injuries [aOR 0.17 (0.10–0.28), P<0.001], and upper facial injuries [aOR 0.41 (0.31–0.54), P<0.001]. Conversely, helmet use increased the odds of lower facial injuries [aOR 1.48 (1.07–2.05), P=0.018]. Strong associations were found between lower face soft tissue injuries and mandible fractures [aOR 29.27 (15.50–55.30), P<0.001] and between soft tissue injuries of the midface and nasal bone fractures [aOR 22.70 (12.52–41.16), P<0.001]. Thus, craniofacial soft tissue injuries in cyclists are influenced by age, sex, and helmet use. Helmet use is associated with decreased odds of soft tissue injury of the upper face but with increased odds of soft tissue injury of the lower facial third.

• Aarhus, Mads; Rønning, Pål Andre; Vik-Mo, Einar Osland; Marthinsen, Pål Bache; Ramm-Pettersen, Jon-Terje & Eide, Per Kristian [Show all 7 contributors for this article] (2025). Kolloidcyster i tredje hjerneventrikkel. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(2). doi: 10.4045/tidsskr.24.0500. Full text in Research Archive
• Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Sorteberg, Angelika; Padayachy, Llewellyn & Helseth, Eirik [Show all 7 contributors for this article] (2025). Real-Time Automated Measurements of Optic Nerve Sheath Diameter for Noninvasive Assessment of Intracranial Pressure in Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care. ISSN 1541-6933. 42, p. 1043–1053. doi: 10.1007/s12028-024-02194-w. Full text in Research Archive Show summary

  Background Optic nerve sheath diameter (ONSD) is a promising noninvasive parameter for intracranial pressure (ICP) assessment. However, in the setting of aneurysmal subarachnoid hemorrhage (aSAH), several previous studies have reported no association between ultrasonically measured ONSD and ICP. In this study, we evaluate ONSD in patients with aSAH using a novel method of automated real-time ultrasonographic measurements and explore whether factors such as having undergone surgery affects its association to ICP. Methods We prospectively included adult patients with aSAH undergoing invasive ICP monitoring. ONSD was obtained using a prototype ultrasound machine with software for real-time automated measurements at the bedside. Correlation between ONSD and ICP was explored, and the ability of ONSD to discriminate dichotomized ICP was evaluated. Abovementioned analyses were performed for the whole cohort and repeated for subgroups by whether the basal cisterns had been surgically entered before ultrasound examination. Results Twenty-six ultrasound examinations were performed in 20 patients. There was a positive correlation between ONSD and ICP (R = 0.43; p = 0.03). In the subgroup where the basal cisterns had not been surgically entered before ultrasound examination, there was a stronger correlation (R = 0.55; p = 0.01), whereas no correlation was seen in the subgroup where the basal cisterns had been surgically entered (R = − 0.16; p = 0.70). ONSD displayed an ability to discriminate ICP dichotomized at ≥ 15 mm Hg (area under the curve [AUC] = 0.84, 95% confidence interval [CI] 0.65–0.96). Subgroup analysis revealed a perfect discriminatory ability (AUC = 1, 95% CI 0.81–1) where the basal cisterns had not been surgically entered and no discriminatory ability (AUC = 0.47, 95% CI 0.16–0.84) where the basal cisterns had been surgically entered before ultrasound examination. Conclusions Automatically measured ONSD correlated well with ICP and displayed a perfect discriminatory ability in patients with aSAH in whom the basal cisterns had not been entered surgically before ultrasound examination, and may be a clinically valuable noninvasive marker of ICP in these patients. Caution should be exercised in using ONSD in patients in whom the basal cisterns have been entered surgically before ONSD measurements, as no association was observed in this subgroup.

• Gupta, Deepak; Singh, Ranjit D.; Vreeburg, Rick Jg; Dijck, Jeroen T.J.M. van; Boogert, Hugo den & Sharma, Kaveri [Show all 74 contributors for this article] (2024). Disparities in casemix, acute interventions, discharge destinations and mortality of patients with traumatic brain injury between Europe and India. Journal of Global Health. ISSN 2047-2978. doi: 10.7189/jogh.14.04227. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is a major global health problem that disproportionally affects low- and middle-income countries. The needs for patients with TBI therefore may differ between levels of national development. We aimed to describe differences in epidemiology and acute care provision of TBI between India and Europe. Methods We used data from two prospective observational registry studies – the Collaborative Indian NeuroTrauma Effectiveness Research in TBI (CINTER-TBI) and the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI), which included TBI patients with an indication for brain CT-scan presenting to 65 centres across Europe and Israel and two trauma centres in India. We performed descriptive analyses of demographic, injury, and treatment characteristics and used random-effects logistic regression with covariate adjustment to examine the likelihood of acute neurosurgical interventions and in-hospital mortality. Results We included 22 849 patients from CENTE

• Gheorghiu, Ana; Brunborg, Cathrine; Johannessen, Tom Børge; Helseth, Eirik; Zwart, John Anker Henrik & Wiedmann, Markus (2024). Life-style and metabolic factors do not affect risk for glioma: a prospective population-based study (The Cohort of Norway). Frontiers in Oncology. 14, p. 1–13. doi: 10.3389/fonc.2024.1471733. Full text in Research Archive Show summary

  Background: The identification of modifiable risk factors for intracranial glioma remains a significant challenge. While lifestyle factors and metabolic syndrome are well-established risk factors for various other cancers, their association with glioma risk remains unclear. Objectives: This study aims to conduct a comprehensive analysis of lifestyle factors and metabolic factors in relation to glioma risk. Methods: The Cohort of Norway (CONOR) is a prospective, population-based health survey encompassing anthropometric measurements, blood tests and health questionnaires. CONOR data were linked to the National Cancer Registry to identify incident glioma cases. Follow-up time was calculated in person-years from the baseline examination until the date of glioma diagnosis, death, or the end of the follow-up period. Cox proportional hazards regression was used to calculate hazard ratios (HR). Results: The study cohort included 160,938 women and men. Over 2.8 million person-years of follow-up, 319 intracranial gliomas were diagnosed. Lifestyle factors such as physical activity, alcohol consumption, smoking, and marital status were not associated with glioma risk. There was no increased glioma risk among participants with diabetes mellitus or hypertension. Furthermore, metabolic syndrome in both women and men was not associated with an elevated risk of glioma. Blood lipids, including total cholesterol, triglycerides, and HDL, were not linked to glioma risk. However, increasing LDL levels were associated with a decreased risk of glioma in men (HR per category 0.84; 95% CI 0.74-0.96), but not in women. Conclusion: This is the first comprehensive prospective cohort study to evaluate potentially modifiable risk factors for glioma. Our findings do not support previously suggested associations between smoking, alcohol consumption, or metabolic syndrome and glioma risk.

• Samanta, Romit J; Chiollaz, Anne-Cécile; Needham, Edward; Yue, John K; Helmy, Adel & Zanier, Elisa R. [Show all 61 contributors for this article] (2024). Parsimonious immune-response endotypes and global outcome in patients with traumatic brain injury. EBioMedicine. 118. doi: 10.1016/j.ebiom.2024.105310. Full text in Research Archive Show summary

  Background: The inflammatory response in patients with traumatic brain injury (TBI) offers opportunities for stratification and intervention. Previous unselected approaches to immunomodulation in patients with TBI have not improved patient outcomes. Methods: Serum and plasma samples from two prospective, multi-centre observational studies of patients with TBI were used to discover (Collaborative European NeuroTrauma Effectiveness Research [CENTER-TBI], Europe) and validate (Transforming Research and Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI] Pilot, USA) individual variations in the immune response using a multiplex panel of 30 inflammatory mediators. Mediators that were associated with unfavourable outcomes (Glasgow outcome score-extended [GOS-E] ≤ 4) were used for hierarchical clustering to identify patients with similar signatures. Findings: Two clusters were identified in both the discovery and validation cohorts, termed early-inflammatory and pauci-inflammatory. The early-inflammatory phen

• Gheorghiu, Anamaria; Brunborg, Cathrine; Johannessen, Tom Børge; Helseth, Eirik; Zwart, John Anker Henrik & Wiedmann, Markus (2024). Lifestyle and metabolic factors affect risk for meningioma in women: a prospective population-based study (The Cohort of Norway). Frontiers in Oncology. 14. doi: 10.3389/fonc.2024.1428142. Full text in Research Archive Show summary

  Background: Meningioma is the most common primary brain tumor, with a clear preponderance in women. Obesity is considered a risk factor for the development of meningioma. Obesity is also the clinical hallmark of metabolic syndrome, characterized by glucose intolerance, dyslipidemia, and hypertension. Lifestyle and metabolic factors directly impact overweight and obesity and are therefore potential risk factors for meningioma development. The aim of this study is to assess lifestyle and metabolic factors for meningioma risk in women. Methods: The Cohort of Norway (CONOR) is a nationwide health survey, conducted between 1994 and 2003, including anthropometric measures, blood tests, and health questionnaires. Linkage to the National Cancer Registry enabled the identification of intracranial meningioma during follow-up until December 2018. Results: A total of 81,652 women were followed for a combined total of 1.5 million years, and 238 intracranial meningiomas were identified. Increasing levels of physical activity (HR 0.81; 95% CI 0.68–0.96; p trend <0.02) and parity (HR 0.83; 95% CI 0.71–0.97; p trend <0.03) were negatively associated with meningioma risk. Diabetes mellitus or glucose intolerance increased the risk for meningioma (HR 2.54; 95% CI 1.60–4.05). Overweight and obesity were not associated with meningioma risk, nor was metabolic syndrome. However, participants without metabolic dysfunction had a reduced meningioma risk, while participants with all five metabolic factors present had a 4-fold risk increase for meningioma (HR 4.28; 95% CI 1.34–13.68). Conclusion: Lifestyle factors seem to significantly influence meningioma risk. However, disentangling the complex associations and interactions between factors for meningioma risk will be a challenging task for future studies.

• Rydning, pål Nicolay; Linnerud, Hege; MIRZAMOHAMMADI, JALAL; Brommeland, Tor; Rønning, Pål Andre & Mejlænder-Evjensvold, Magnus [Show all 9 contributors for this article] (2024). Decreasing incidence of cervical spine fractures in patients with ankylosing spondylitis: a population-based study in Southeast Norway. The spine journal. ISSN 1529-9430. 24(8), p. 1502–1509. doi: 10.1016/j.spinee.2024.03.004. Full text in Research Archive Show summary

  Background Context Individuals diagnosed with ankylosing spondylitis (AS) face an increased risk of spine fractures, specifically cervical spine fractures (CS-Fxs). In the past two decades, biological disease-modifying antirheumatic drugs (bDMARDs) have provided considerable relief from pain and an enhanced sense of wellbeing for a large segment of AS patients. Despite these improvements, it remains unclear whether extended use of bDMARDs can indeed reduce the risk of spine fractures. Purpose In this study, we aimed to investigate the evolving patterns and epidemiology of traumatic CS-Fxs in both AS and non-AS populations. We hypothesized that the risk of CS-Fxs among AS patients would show a decreasing trend over time, while the risk among non-AS patients would remain constant. Study Design/Setting Retrospective cohort study based on a prospective database. Patient Sample A total of 3,598 consecutive patients with CS-Fxs were treated at Oslo University Hospital over an 8-year period. Outcome Measures CS-Fxs in AS patients were contrasted with non-AS-related CS-Fxs in terms of temporal trends, age, sex, injury mechanism, associated cervical spinal cord injury (cSCI), need for surgical fixation, and 30-day mortality. Methods Data regarding all CS-Fxs diagnosed between 2015 and 2022 were extracted from the Southeast Norway population-based quality control database for traumatic CS-Fxs. Categorical data were summarized using frequencies, and continuous data were summarized using medians. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-squared test and Fischer exact test were used to compare categorical variables. To investigate the trend in the incidence of fractures, two different Poisson models were fitted with the number of non-AS and AS fractures as dependent variables and the year as the explanatory variable. Results Over an 8-year period, we registered 3,622 CS-Fxs in 3598 patients, with AS patients accounting for 125 of these fractures. Relative to their non-AS counterparts, AS patients presented a 9-fold and 8-fold higher risk of initial and subsequent CS-Fxs, respectively. We observed a declining trend in AS-related CS-Fxs with an annual linear decrease of 8.4% (p=.026), whereas non-AS-related CS-Fxs showed an annual linear increase of 3.7% (p<.001). AS patients sustaining CS-Fxs were typically older (median age 70 vs 63 years), predominantly male (89% vs 67%), and more frequently experienced injuries due to falls (82% vs 57%). They also exhibited a higher prevalence of subaxial CS-Fxs (91% vs 62%), fewer C0-C2 CS-Fxs (14% vs 44%), a higher rate of associated cSCI (21% vs 11%), and a greater tendency for surgical fixation (66% vs 21%). We observed a 30-day mortality rate of 11% in AS patients and 5.4% in non-AS patients (p=.005). Conclusions The results of this study confirm the elevated risk of CS-Fxs among AS patients, although this risk appears to show a decreasing trend. The most plausible explanation for this risk reduction is the widespread application of bDMARDs

• Howe, Emilie Isager; Andelic, Nada; Brunborg, Cathrine; Zeldovich, Marina; Helseth, Eirik & Skandsen, Toril [Show all 25 contributors for this article] (2024). Frequency and predictors of headache in the first 12 months after traumatic brain injury: results from CENTER-TBI. The Journal of Headache and Pain. ISSN 1129-2369. 25(1). doi: 10.1186/s10194-024-01751-0. Full text in Research Archive Show summary

  Background: Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury. Methods: A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors. Results: A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury. Conclusions: Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache. Trial registration: ClinicalTrials.gov NCT02210221.

• Kals, Mart; Wilson, Lindsay; Levey, Daniel F.; Parodi, Livia; Steyerberg, Ewout W. & Richardson, Sylvia [Show all 79 contributors for this article] (2024). Genetic vulnerability and adverse mental health outcomes following mild traumatic brain injury: a meta-analysis of CENTER-TBI and TRACK-TBI cohorts. EClinicalMedicine. doi: 10.1016/j.eclinm.2024.102956. Full text in Research Archive Show summary

  Background Post-traumatic stress disorder (PTSD) and depression are common after mild traumatic brain injury (mTBI), but their biological drivers are uncertain. We therefore explored whether polygenic risk scores (PRS) derived for PTSD and major depressive disorder (MDD) are associated with the development of cognate TBI-related phenotypes. Methods Meta-analyses were conducted using data from two multicenter, prospective observational cohort studies of patients with mTBI: the CENTER-TBI study (ClinicalTrials.gov ID NCT02210221) in Europe (December 2014–December 2017) and the TRACK-TBI study in the US (March 2014–July 2018). In both cohorts, the most common causes of injury were road traffic accidents and falls. Primary outcomes, specifically probable PTSD and depression, were defined at 6 months post-injury using scores ≥33 on the PTSD Checklist-5 and ≥15 on the Patient Health Questionnaire-9, respectively. We calculated PTSD-PRS and MDD-PRS for patients aged ≥17 years who had a Glasgow Coma Scale score of 13

• Richter, Sophie; Winzeck, Stefan; Correia, Marta M.; Czeiter, Endre; Whitehouse, Daniel & Kornaropoulos, Evgenios N. [Show all 53 contributors for this article] (2024). Predicting recovery in patients with mild traumatic brain injury and a normal CT using serum biomarkers and diffusion tensor imaging (CENTER-TBI): an observational cohort study. EClinicalMedicine. 75. doi: 10.1016/j.eclinm.2024.102751. Full text in Research Archive Show summary

  Background Even patients with normal computed tomography (CT) head imaging may experience persistent symptoms for months to years after mild traumatic brain injury (mTBI). There is currently no good way to predict recovery and triage patients who may benefit from early follow-up and targeted intervention. We aimed to assess if existing prognostic models can be improved by serum biomarkers or diffusion tensor imaging metrics (DTI) from MRI, and if serum biomarkers can identify patients for DTI. Methods We included 1025 patients aged >18 years with a Glasgow Coma Score >12 and normal CT from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study which recruited between December 19,2014 and December 17, 2017 (NCT02210221). Biomarkers (GFAP, NFL, S100B) were obtained at a median of 8.8 h (Q1–Q3 4.2–16.7) and DTI at 13 days (3–19) after injury. DTI metrics were available in 153 patients for 48 white matter tracts (ICBM-DTI-81 atlas). Incomplete recovery at three months was defined as an extended Glasgow Outcome Scale score <8. Existing prognostic models were fitted with and without biomarkers, or with and without DTI, and internally validated using bootstrapping. Findings 385 (38%) patients had incomplete recovery. Adding biomarkers did not improve performance beyond the best existing clinical prognostic model [optimism-corrected AUC 0.69 (95% CI 0.65–0.72) and R2 17% (11–22)]. Adding DTI metrics significantly enhanced all models [best optimism-corrected AUC 0.82 (0.79–0.85) and R2 75% (39–100)]. The top three prognostic tracts were the left posterior thalamic radiation, left superior cerebellar peduncle and right uncinate fasciculus. Serum biomarkers could have avoided 1 in 5 DTI scans, with GFAP <12 h and NFL 12–24 h from injury performing best. Interpretation DTI substantially improved existing prognostic models for functional outcome in patients with mTBI and a normal CT, and biomarkers could help select patients for MRI. If validated, DTI could allow for targeted follow-up and enrichment of clinical trials of early interventions to improve outcome.

• Sødal, Hild Flatmark; Nordseth, Trond; Rasmussen, Anders Johan Orland; Rosseland, Leiv Arne; Stenehjem, Jo & Gran, Jon Michael [Show all 8 contributors for this article] (2024). Risk of epilepsy after traumatic brain injury: a nationwide Norwegian matched cohort study. Frontiers in Neurology. 15. doi: 10.3389/fneur.2024.1411692. Full text in Research Archive Show summary

  Background: Post-traumatic epilepsy (PTE) is a well-known complication of traumatic brain injury (TBI). Although several risk factors have been identified, prediction of PTE is difficult. Changing demographics and advances in TBI treatment may affect the risk of PTE. Our aim was to provide an up-to-date estimate of the incidence of PTE by linking multiple nationwide registers. Methods: Patients with TBI admitted to hospital 2015-2018 were identified in the Norwegian Trauma Registry and matched to trauma-free controls on sex and birth year according to a matched cohort design. They were followed up for epilepsy in nationwide registers 2015-2020. Cumulative incidence of epilepsy in TBI patients and controls was estimated taking competing risks into account. Analyses stratified by the Abbreviated Injury Scale (AIS) severity score, Glasgow Coma Scale score and age were conducted for the TBI group. Occurrence of PTE in different injury types was visualized using UpSet plots. Results: In total, 8,660 patients and

• Wilson, Lindsay; Newcombe, Virginia FJ; Whitehouse, Daniel P; Mondello, Stefania; Maas, Andrew I. R. & Menon, David K. [Show all 52 contributors for this article] (2024). Association of early blood-based biomarkers and six-month functional outcomes in conventional severity categories of traumatic brain injury: capturing the continuous spectrum of injury. EBioMedicine. doi: 10.1016/j.ebiom.2024.105298. Full text in Research Archive Show summary

  Background Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity.

• Brommeland, Tor; Strøm, Mona; MIRZAMOHAMMADI, JALAL; Glott, Thomas; Linnerud, Hege & Rønning, Pål Andre [Show all 12 contributors for this article] (2024). Traumatic cervical spinal cord injury in southeastern Norway: acute treatment, specialized rehabilitation referral and mortality. Frontiers in Neurology. 15. doi: 10.3389/fneur.2024.1452194. Full text in Research Archive Show summary

  Background: Traumatic cervical spinal cord injury (cSCI) is a serious condition that requires a multidisciplinary treatment approach involving care at a neurotrauma center (NTC) and specialized rehabilitation. Contemporary population-based studies of cSCI are important for ensuring the quality and planning of health care approaches for these patients. Methods: This is a population-based cohort study of patients with traumatic cSCI who were admitted to the NTC in Southeast Norway between 2015 and 2022. The main outcome variables were length of stay (LOS), rate of surgical fixation/stabilization, rate of transfer to specialized rehabilitation, and 90-day mortality. Uni-and multivariate binary logistic regression analyses were used to investigate the effect of different covariates on LOS, transfer to specialized rehabilitation and 90-day mortality. Results: The median age of the 370 patients admitted to the NTC was 64 years, 75% were males, 40% had severe comorbidities, 45% had multiple injuries, and 67% underwent primary triage at a local hospital (LH). Surgical cervical stabilization/decompression was performed in 78% of the patients. The median LOS at the NTC was 9 days, and increasing LOS was significantly associated with young age, American Spinal Injury Association Impairment Scale (AIS) grade B, surgery and prolonged ventilatory support. Inpatient specialized rehabilitation was provided to 54% of patients. Receiving specialized rehabilitation was associated with younger age, preinjury independent living, more severe cSCI, no need for acute phase tracheostomy, and surgical stabilization/decompression. Only 6% of the octogenarians received specialized rehabilitation. The 90-day mortality rate was 13%, which was associated with older age, preinjury dependent living, more severe cSCI, upper cervical injuries, and days on ventilator and inversely correlated with LOS. Conclusion: Advanced age, especially among octogenarians, was significantly linked to a lack of specialized rehabilitation. Qualified physicians should assess all patients with cSCI for their need of rehabilitation and their potential to benefit from it. If the number of patients who are likely to respond to rehabilitation outnumbers the capacity of the rehabilitation center, we have two choices. Either guidelines for prioritization of patients for rehabilitation should be developed, or the capacity of the rehabilitation centers should be increased.

• Galteland, Pål; Døving, Mats; Sehic, Amer; Utheim, Tor Paaske; Næss, Ingar & Eken, Torsten [Show all 9 contributors for this article] (2024). Do Bicycle Helmets Protect Against Facial Fractures? An Observational Study From a Level 1 Trauma Centre. The Journal of craniofacial surgery (Print). ISSN 1049-2275. 35(5), p. 1325–1328. doi: 10.1097/SCS.0000000000010181. Full text in Research Archive
• Galteland, Pål; Døving, Mats; Næss, Ingar; Sehic, Amer; Utheim, Tor Paaske & Eken, Torsten [Show all 9 contributors for this article] (2024). The association between head injury and facial fracture treatment: an observational study of hospitalized bicyclists from a level 1 trauma centre. Acta Neurochirurgica. ISSN 0001-6268. 166(1). doi: 10.1007/s00701-024-06019-9. Full text in Research Archive Show summary

  Purpose To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. Methods Retrospective analysis of data from bicycle-related injuries in the period 2005–2016 extracted from the Oslo University Hospital trauma registry. Results A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1–2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3–6). The mean patient age was 40.2 years (range 3–91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03–3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30–8.60, p = 0.012). Conclusion Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit.

• Vyvere, Thijs Vande; Pisicǎ, Dana; Wilms, Guido; Claes, Lene; Dyck, Pieter Van & Snoeckx, Annemiek [Show all 261 contributors for this article] (2024). Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. Journal of Neurotrauma. ISSN 0897-7151. 41(19-20), p. 2248–2297. doi: 10.1089/neu.2023.0553. Full text in Research Archive Show summary

  In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.

• Robba, Chiara; Graziano, Francesca; Picetti, Edoardo; Åkerlund, Cecilia; Addis, Alberto & Pastore, Giuseppe [Show all 72 contributors for this article] (2024). Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data. Intensive Care Medicine. ISSN 0342-4642. doi: 10.1007/s00134-024-07324-8. Full text in Research Archive Show summary

  Purpose: We analysed the impact of early systemic insults (hypoxemia and hypotension, SIs) on brain injury biomarker profiles, acute care requirements during intensive care unit (ICU) stay, and 6-month outcomes in patients with traumatic brain injury (TBI). Methods: From patients recruited to the Collaborative European neurotrauma effectiveness research in TBI (CENTER-TBI) study, we documented the prevalence and risk factors for SIs and analysed their effect on the levels of brain injury biomarkers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and protein Tau], critical care needs, and 6-month outcomes [Glasgow Outcome Scale Extended (GOSE)]. Results: Among 1695 TBI patients, 24.5% had SIs: 16.1% had hypoxemia, 15.2% had hypotension, and 6.8% had both. Biomarkers differed by SI category, with higher S100B, Tau, UCH-L1, NSE and NfL values in patients with hypotension or both SIs. The ratio of neural to glial injury (quantified as UCH-L1/GFAP and Tau/GFAP ratios) was higher in patients with hypotension than in those with no SIs or hypoxia alone. At 6 months, 380 patients died (22%), and 759 (45%) had GOSE ≤ 4. Patients who experienced at least one SI had higher mortality than those who did not (31.8% vs. 19%, p < 0.001). Conclusion: Though less frequent than previously described, SIs in TBI patients are associated with higher release of neuronal than glial injury biomarkers and with increased requirements for ICU therapies aimed at reducing intracranial hypertension. Hypotension or combined SIs are significantly associated with adverse 6-month outcomes. Current criteria for hypotension may lead to higher biomarker levels and more negative outcomes than those for hypoxemia suggesting a need to revisit pressure targets in the prehospital settings.

• Zheng, Jiang; Ouyang, Yufang; Zhang, Ke; Wang, Zhixing; Younsi, Alexander & Alhalabi, Obada [Show all 54 contributors for this article] (2024). Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury. JAMA Network Open. doi: 10.1001/jamanetworkopen.2024.1556. Full text in Research Archive Show summary

  Importance: The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial. Objective: To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI. Design, setting, and participants: This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023. Main outcomes and measures: The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale-Extended [GOSE] score ≤4). Results: A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90). Conclusions and relevance: The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.

• Ntikas, Michail; Stewart, William; Ietswaart, Magdalena; Hunter, Angus M.; Maas, Andrew I R & Menon, David K [Show all 57 contributors for this article] (2024). Contrasting Characteristics and Outcomes of Sports-Related and Non-Sports-Related Traumatic Brain Injury. JAMA Network Open. 7. doi: 10.1001/jamanetworkopen.2023.53318. Full text in Research Archive Show summary

  Importance: Exposure to traumatic brain injury (TBI) has raised widespread concern over participation in sports, particularly over possible long-term consequences. However, little is known about the outcomes of individuals presenting to hospitals with sports-related TBI. Objective: To compare the characteristics and outcomes of individuals presenting to hospitals with sports-related and non-sports-related TBI. Design, setting, and participants: The CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) observational cohort study was conducted at hospitals in 18 countries. The study enrolled 4509 patients who had TBI and had an indication for computed tomography (CT), of whom 4360 were 16 years or older. Outcomes were assessed at 3 and 6 months, and groups were compared using regression analyses adjusting for clinical and demographic differences. Data were collected between December 9, 2014, and December 17, 2017, and analyzed from August 2022 to March 2023. Exposure: Sports-related and non-sports-related TBI with subgroups selected by severity of injury. Main outcomes and measures: The main outcome was the Glasgow Outcome Scale-Extended (GOSE) at 6 months, with secondary outcomes covering postconcussion symptoms, health-related quality of life, and mental health. Results: A total of 4360 patients were studied, including 256 (6%) with sports-related TBI (mean [SD] age, 38.9 [18.1] years; 161 [63%] male) and 4104 with non-sports-related TBI (mean [SD] age, 51.0 [20.2] years; 2773 [68%] male). Compared with patients with non-sports-related TBI, patients with sports-related TBI were younger, more likely to have tertiary education, more likely to be previously healthy, and less likely to have a major extracranial injury. After adjustment, the groups did not differ in incomplete recovery (GOSE scores <8) at 6 months (odds ratio [OR], 1.27; 95% CI, 0.90-1.78; P = .22 for all patients; OR, 1.20; 95% CI, 0.83-1.73; P = .34 for those with mild TBI; and OR, 1.19; 95% CI, 0.74-1.92; P = .65 for those with mild TBI and negative CT findings). At 6 months, there was incomplete recovery in 103 of 223 patients (46%) with outcomes in the sports-related TBI group, 65 of 168 (39%) in those with mild sports-related TBI, and 30 of 98 (31%) in those with mild sports-related TBI and negative CT findings. In contrast, at 6 months, the sports-related TBI group had lower prevalence of anxiety, depression, posttraumatic stress disorder, and postconcussion symptoms than the non-sports-related group. Conclusions and relevance: In this cohort study of 4360 patients with TBI, functional limitations 6 months after injury were common after sports-related TBI, even mild sports-related TBI. Persisting impairment was evident in the sports-related TBI group despite better recovery compared with non-sports-related TBI on measures of mental health and postconcussion symptoms. These findings caution against taking an overoptimistic view of outcomes after sports-related TBI, even if the initial injury appears mild.

• Hovset, Camilla Guren; Røe, Cecilie; Søberg, Helene L.; Brunborg, Cathrine; Helseth, Eirik & Andelic, Nada [Show all 7 contributors for this article] (2024). Patient satisfaction with rehabilitation services following traumatic brain injury: a quality registry study. Journal of Rehabilitation Medicine. ISSN 1650-1977. 56. doi: 10.2340/jrm.v56.35115. Full text in Research Archive Show summary

  Objective: To examine factors associated with patient satisfaction with rehabilitation services received after traumatic brain injury. Design: Cross-sectional study. Subjects/Patients: Persons with mild to severe traumatic brain injury (n = 1,375) registered in the “Oslo TBI Registry – Rehabilitation” quality register at Oslo University Hospital from 1 January 2018–31 July 2022. Methods: Sociodemographics, injury-related variables, patient-reported outcome measures, global func­ tioning, and rehabilitation-related variables were recorded at hospital outpatient visits. The patients reported satisfaction with services receiv­ed at the outpatient clinic and in primary healthcare at the final follow-up. Multivariable logistic regression models were applied to examine factors associated with patient satisfaction. Results: Of 316 patients, 83% reported satisfaction with services received at the hospital outpatient clinic. Belief in recovery (odds ratio [OR] = 2.73), shorter time to follow-up (OR = 0.39), and lower symptom burden (OR = 0.96) significantly increased satisfaction. Among 283 patients, 62% reported satisfaction with services in primary healthcare, where belief in recovery (OR = 2.90), shorter time to follow-up (OR = 0.50), higher age (OR = 1.04), and higher number of rehabilitation services received in primary healthcare (OR = 1.32) significantly increased satisfaction. Conclusion: Across service levels, the strongest associated factors for satisfaction were belief in recovery and shorter time to follow-up, suggesting that timely delivery of traumatic brain injury-related specialized services could increase overall satisfaction.

• Deynse, Helena Van; Cools, Wilfried; Deken, Viktor-Jan De; Depreitere, Bart; Hubloue, Ives & Tisseghem, Ellen [Show all 257 contributors for this article] (2024). One-year employment outcome prediction after traumatic brain injury: A CENTER-TBI study. Disability and Health Journal. ISSN 1936-6574. doi: 10.1016/j.dhjo.2024.101716. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) can come with long term consequences for functional outcome that can complicate return to work. Objectives This study aims to make accurate patient-specific predictions on one-year return to work after TBI using machine learning algorithms. Within this process, specific research questions were defined: 1 How can we make accurate predictions on employment outcome, and does this require follow-up data beyond hospitalization? 2 Which predictors are required to make accurate predictions? 3 Are predictions accurate enough for use in clinical practice? Methods This study used the core CENTER-TBI observational cohort dataset, collected across 18 European countries between 2014 and 2017. Hospitalized patients with sufficient follow-up data were selected for the current analysis (N = 586). Data regarding hospital stay and follow-up until three months post-injury were used to predict return to work after one year. Three distinct algorithms were used to predict employment outcomes: elastic net logistic regression, random forest and gradient boosting. Finally, a reduced model and corresponding ROC-curve was created. Results Full models without follow-up achieved an area under the curve (AUC) of about 81 %, which increased up to 88 % with follow-up data. A reduced model with five predictors achieved similar results with an AUC of 90 %.

• Prysiazhniuk, Yeva; Server, Andrés; Leske, Henning; Gadmar, Øystein Bech; Helseth, Eirik & Eijgelaar, Roelant Sjouke [Show all 12 contributors for this article] (2024). Diffuse glioma molecular profiling with arterial spin labeling and dynamic susceptibility contrast perfusion MRI: A comparative study. Neuro-Oncology Advances (NOA). 6(1). doi: 10.1093/noajnl/vdae113. Full text in Research Archive Show summary

  Background Evaluation of molecular markers (IDH, pTERT, 1p/19q codeletion, and MGMT) in adult diffuse gliomas is crucial for accurate diagnosis and optimal treatment planning. Dynamic Susceptibility Contrast (DSC) and Arterial Spin Labeling (ASL) perfusion MRI techniques have both shown good performance in classifying molecular markers, however, their performance has not been compared side-by-side. Methods Pretreatment MRI data from 90 patients diagnosed with diffuse glioma (54 men/36 female, 53.1 ± 15.5 years, grades 2–4) were retrospectively analyzed. DSC-derived normalized cerebral blood flow/volume (nCBF/nCBV) and ASL-derived nCBF in tumor and perifocal edema were analyzed in patients with available IDH-mutation (n = 67), pTERT-mutation (n = 39), 1p/19q codeletion (n = 33), and MGMT promoter methylation (n = 31) status. Cross-validated uni- and multivariate logistic regression models assessed perfusion parameters’ performance in molecular marker detection. Results ASL and DSC perfusion parameters in tumor and edema distinguished IDH-wildtype (wt) and pTERT-wt tumors from mutated ones. Univariate classification performance was comparable for ASL-nCBF and DSC-nCBV in IDH (maximum AUROCC 0.82 and 0.83, respectively) and pTERT (maximum AUROCC 0.70 and 0.81, respectively) status differentiation. The multivariate approach improved IDH (DSC-nCBV AUROCC 0.89) and pTERT (ASL-nCBF AUROCC 0.8 and DSC-nCBV AUROCC 0.86) classification. However, ASL and DSC parameters could not differentiate 1p/19q codeletion or MGMT promoter methylation status. Positive correlations were found between ASL-nCBF and DSC-nCBV/-nCBF in tumor and edema. Conclusions ASL is a viable gadolinium-free replacement for DSC for molecular characterization of adult diffuse gliomas.

• Vreeburg, Rick J G; Singh, Ranjit D.; Erp, Inge A M van; Korhonen, Tommi K; Yue, John K & Mee, Harry [Show all 81 contributors for this article] (2024). Early versus delayed cranioplasty after decompressive craniectomy in traumatic brain injury: a multicenter observational study within CENTER-TBI and Net-QuRe. Journal of Neurosurgery. ISSN 0022-3085. 141(4), p. 895–907. doi: 10.3171/2024.1.JNS232172. Full text in Research Archive Show summary

  OBJECTIVE The aim of this study was to compare the outcomes of early (≤ 90 days) and delayed (> 90 days) cranioplasty following decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). METHODS The authors analyzed participants enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and the Neurotraumatology Quality Registry (Net-QuRe) studies who were diagnosed with TBI and underwent DC and subsequent cranioplasty. These prospective, multicenter, observational cohort studies included 5091 patients enrolled from 2014 to 2020. The effect of cranioplasty timing on functional outcome was evaluated with multivariable ordinal regression and with propensity score matching (PSM) in a sensitivity analysis of functional outcome (Glasgow Outcome Scale–Extended [GOSE] score) and quality of life (Quality of Life After Brain Injury [QOLIBRI] instrument) at 12 months following DC. RESULTS Among 173 eligible patients, 73 (42%) underwent early cra

• Pisică, Dana; Volovici, Victor; Yue, John K; Essen, Thomas A. Van; Boogert, Hugo F den & Vyvere, Thijs Vande [Show all 73 contributors for this article] (2024). Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study. Neurosurgery. ISSN 0148-396X. doi: 10.1227/neu.0000000000002982. Full text in Research Archive Show summary

  BACKGROUND AND OBJECTIVES: Guideline recommendations for surgical management of traumatic epidural hematomas (EDHs) do not directly address EDHs that co-occur with other intracranial hematomas; the relative rates of isolated vs nonisolated EDHs and guideline adherence are unknown. We describe characteristics of a contemporary cohort of patients with EDHs and identify factors influencing acute surgery. METHODS: This research was conducted within the longitudinal, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury cohort study which prospectively enrolled patients with traumatic brain injury from 65 hospitals in 18 European countries from 2014 to 2017. All patients with EDH on the first scan were included. We describe clinical, imaging, management, and outcome characteristics and assess associations between site and baseline characteristics and acute EDH surgery, using regression modeling. RESULTS: In 461 patients with EDH, median age was 41 years (IQR 24-56),

• Woodrow, Rebecca E; Menon, David K; Stamatakis, Emmanuel A; Amrein, Krisztina; Andelic, Nada & Andreassen, Lasse [Show all 51 contributors for this article] (2024). Repeat traumatic brain injury exacerbates acute thalamic hyperconnectivity in humans. Brain Communications. 6(4). doi: 10.1093/braincomms/fcae223. Full text in Research Archive Show summary

  Repeated mild traumatic brain injury is of growing interest regarding public and sporting safety and is thought to have greater adverse or cumulative neurological effects when compared with single injury. While epidemiological links between repeated traumatic brain injury and outcome have been investigated in humans, exploration of its mechanistic substrates has been largely undertaken in animal models. We compared acute neurological effects of repeat mild traumatic brain injury (n = 21) to that of single injury (n = 21) and healthy controls (n = 76) using resting-state functional MRI and quantified thalamic functional connectivity, given previous identification of its prognostic potential in human mild traumatic brain injury and rodent repeat mild traumatic brain injury. Acute thalamocortical functional connectivity showed a rank-based trend of increasing connectivity with number of injuries, at local and global scales of investigation. Thus, history of as few as two previous injuries can induce a vulnerable

• Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Padayachy, Llewellyn; Helseth, Eirik & Brekken, Reidar (2024). Noninvasive Assessment of Intracranial Pressure: Deformability Index as an Adjunct to Optic Nerve Sheath Diameter to Increase Diagnostic Ability. Neurocritical Care. ISSN 1541-6933. 41, p. 479–488. doi: 10.1007/s12028-024-01955-x. Full text in Research Archive Show summary

  Background Today, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we ask whether combining DI with optic nerve sheath diameter (ONSD), a more established parameter, results in increased diagnostic ability, as compared to using ONSD alone. Methods We prospectively included adult patients with traumatic brain injury with invasive ICP monitoring, which served as the reference measurement. Ultrasound images and videos of the optic nerve sheath were acquired. ONSD was measured at the bedside, whereas DI was calculated by semiautomated postprocessing of ultrasound videos. Correlations of ONSD and DI to ICP were explored, and a linear regression model combining ONSD and DI was compared to a linear regression model using ONSD alone. Ability of the noninvasive parameters to distinguish dichotomized ICP was evaluated using receiver operating characteristic curves, and a logistic regression model combining ONSD and DI was compared to a logistic regression model using ONSD alone. Results Forty-four ultrasound examinations were performed in 26 patients. Both DI (R =  − 0.28; 95% confidence interval [CI] R <  − 0.03; p = 0.03) and ONSD (R = 0.45; 95% CI R > 0.23; p < 0.01) correlated with ICP. When including both parameters in a combined model, the estimated correlation coefficient increased (R = 0.51; 95% CI R > 0.30; p < 0.01), compared to using ONSD alone, but the model improvement did not reach statistical significance (p = 0.09). Both DI (area under the curve [AUC] 0.69, 95% CI 0.53–0.83) and ONSD (AUC 0.72, 95% CI 0.56–0.86) displayed ability to distinguish ICP dichotomized at ICP ≥ 15 mm Hg. When using both parameters in a combined model, AUC increased (0.80, 95% CI 0.63–0.90), and the model improvement was statistically significant (p = 0.02). Conclusions Combining ONSD with DI holds the potential of increasing the ability of optic nerve sheath parameters in the noninvasive assessment of ICP, compared to using ONSD alone, and further study of DI is warranted.

• Blakstad, Hanne Kristin; Mireles, Eduardo Erasmo Mendoza; Kierulf-Vieira, Kirsten Strømme; Singireddy, Divija; Mdala, Ibrahimu & Heggebø, Liv Cathrine [Show all 16 contributors for this article] (2024). The impact of cancer patient pathway on timing of radiotherapy and survival: a cohort study in glioblastoma patients. Journal of Neuro-Oncology. ISSN 0167-594X. 169, p. 137–145. doi: 10.1007/s11060-024-04709-z. Full text in Research Archive Show summary

  Purpose Glioblastoma (GBM) is an aggressive brain tumor in which primary therapy is standardized and consists of surgery, radiotherapy (RT), and chemotherapy. However, the optimal time from surgery to start of RT is unknown. A high-grade glioma cancer patient pathway (CPP) was implemented in Norway in 2015 to avoid non-medical delays and regional disparity, and to optimize information flow to patients. This study investigated how CPP affected time to RT after surgery and overall survival. Methods This study included consecutive GBM patients diagnosed in South-Eastern Norway Regional Health Authority from 2006 to 2019 and treated with RT. The pre CPP implementation group constituted patients diagnosed 2006–2014, and the post CPP implementation group constituted patients diagnosed 2016–2019. We evaluated timing of RT and survival in relation to CPP implementation. Results A total of 1212 patients with GBM were included. CPP implementation was associated with significantly better outcomes (p < 0.001). Median overall survival was 12.9 months. The odds of receiving RT within four weeks after surgery were significantly higher post CPP implementation (p < 0.001). We found no difference in survival dependent on timing of RT below 4, 4–6 or more than 6 weeks (p = 0.349). Prognostic factors for better outcomes in adjusted analyses were female sex (p = 0.005), younger age (p < 0.001), solitary tumors (p = 0.008), gross total resection (p < 0.001), and higher RT dose (p < 0.001). Conclusion CPP implementation significantly reduced time to start of postoperative RT. Survival was significantly longer in the period after the CPP implementation, however, timing of postoperative RT relative to time of surgery did not impact survival.

• Aarhus, Mads; MIRZAMOHAMMADI, JALAL; Rønning, Pål Andre; Strøm, Mona; Glott, Thomas & Rizvi, Syed Ali Mujtaba [Show all 15 contributors for this article] (2024). Time from injury to acute surgery for patients with traumatic cervical spinal cord injury in South-East Norway. Frontiers in Neurology. 15. doi: 10.3389/fneur.2024.1420530. Full text in Research Archive Show summary

  Background: The recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay. Methods: Population-based retrospective database study of patients operated for cSCI in 2015–2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery. Results: We found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47–74 years), 77% were male, 48% were ≥65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4–61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9–19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5–31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology. Conclusion: Less than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day.

• Næss, Ingar; Døving, Mats; Galteland, Pål; Skaga, Nils Oddvar; Eken, Torsten & Helseth, Eirik [Show all 7 contributors for this article] (2024). Bicycle helmets are associated with fewer and less severe head injuries and fewer neurosurgical procedures. Acta Neurochirurgica. ISSN 0001-6268. 166(1). doi: 10.1007/s00701-024-06294-6. Full text in Research Archive Show summary

  Purpose This study explores the protective capabilities of bicycle helmets on serious head injury among bicyclists hospitalized in a Norwegian level 1 trauma centre. Method Information on helmet use, demographic variables, Abbreviated Injury Scale (AIS) and surgical procedure codes was retrieved from the Oslo University Hospital Trauma Registry for patients with bicycle-related injuries from 2005 through 2016. Outcomes were serious head injury defined as maximum AIS severity score ≥ 3 in the AIS region Head, any cranial neurosurgical procedure, and 30-day mortality. Results A total of 1256 hospitalized bicyclists were included. The median age was 41 years (quartiles 26–53), 73% were male, 5.3% had severe pre-injury comorbidities, and 54% wore a helmet at the time of injury. Serious head injury occurred in 30%, 9% underwent a cranial neurosurgical procedure, and 30-day mortality was 2%. Compared to non-helmeted bicyclists, helmeted bicyclists were older (43 years, quartiles 27–54, vs. 38 years, quartiles 23–53, p = 0.05), less often crashed during night-time (21% vs. 38%, p < 0.001), less frequently had serious head injury (22% vs. 38%, OR 0.29, 95% CI 0.22–0.39), and less often underwent cranial neurosurgery (6% vs. 14%, OR 0.36, 95% CI 0.24–0.54). No statistically significant difference in 30-day mortality between the two groups was found (1.5% vs. 2.9%, OR 0.50, 95% CI 0.22–1.11). Conclusion Helmet use was associated with fewer and less severe head injuries and fewer neurosurgical procedures. This adds evidence to the protective capabilities of bicycle helmets.

• Netteland, Dag Ferner; Sandset, Else Charlotte; Mejlænder-Evjensvold, Magnus; Aarhus, Mads; Jeppesen, Elisabeth & Sousa, Diana [Show all 8 contributors for this article] (2023). Cerebral venous sinus thrombosis in traumatic brain injury: A systematic review of its complications, effect on mortality, diagnostic and therapeutic management, and follow-up. Frontiers in Neurology. 13(2022). doi: 10.3389/fneur.2022.1079579. Full text in Research Archive Show summary

  Objective: Cerebral venous sinus thrombosis (CVST) is increasingly being recognized in the setting of traumatic brain injury (TBI), but its effect on TBI patients and its management remains uncertain. Here, we systematically review the currently available evidence on the complications, effect on mortality and the diagnostic and therapeutic management and follow-up of CVST in the setting of TBI. Methods: Key clinical questions were posed and used to define the scope of the review within the following topics of complications; effect on mortality; diagnostics; therapeutics; recanalization and follow-up of CVST in TBI. We searched relevant databases using a structured search strategy. We screened identified records according to eligibility criteria and for information regarding the posed key clinical questions within the defined topics of the review. Results: From 679 identified records, 21 studies met the eligibility criteria and were included, all of which were observational in nature. Data was deemed insufficiently homogenous to perform meta-analysis and was narratively synthesized. Reported rates of venous infarctions ranged between 7 and 38%. One large registry study reported increased in-hospital mortality in CVSP and TBI compared to a control group with TBI alone in adjusted analyses. Another two studies found midline CVST to be associated with increased risk of mortality in adjusted analyses. Direct data to inform the optimum diagnostic and therapeutic management of the condition was limited, but some data on the safety, and effect of anticoagulation treatment of CVST in TBI was identified. Systematic data on recanalization rates to guide follow-up was also limited, and reported complete recanalization rates ranged between 41 and 86%. In the context of the identified data, we discuss the diagnostic and therapeutic management and follow-up of the condition. Conclusion: Currently, the available evidence is insufficient for evidence-based treatment of CVST in the setting of TBI. However, there are clear indications in the presently available literature that CVST in TBI is associated with complications and increased mortality, and this indicates that management options for the condition must be considered. Further studies are needed to confirm the effects of CVST on TBI patients and to provide evidence to support management decisions.

• Mikolić, Ana; Steyerberg, Ewout W.; Polinder, Suzanne; Wilson, Lindsay; Zeldovich, Marina & Steinbueche, Nicole von [Show all 258 contributors for this article] (2023). Prognostic Models for Global Functional Outcome and Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. Journal of Neurotrauma. ISSN 0897-7151. 40(15-16), p. 1651–1670. doi: 10.1089/neu.2022.0320. Full text in Research Archive Show summary

  After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at present

• Cuevas-Østrem, Mathias; Thorsen, Kjetil; Wisborg, Torben; Røise, Olav; Helseth, Eirik & Jeppesen, Elisabeth (2023). Care pathways and factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe traumatic brain injury: a population-based study from the Norwegian trauma registry. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 31(1). doi: 10.1186/s13049-023-01097-7. Full text in Research Archive Show summary

  Background Systems ensuring continuity of care through the treatment chain improve outcomes for traumatic brain injury (TBI) patients. Non-neurosurgical acute care trauma hospitals are central in providing care continuity in current trauma systems, however, their role in TBI management is understudied. This study aimed to investigate characteristics and care pathways and identify factors associated with interhospital transfer to neurotrauma centers<p> for patients with isolated moderate-to-severe TBI primarily admitted to acute care trauma hospitals. <p>Methods A population-based cohort study from the national Norwegian Trauma Registry (2015–2020) of adult patients (≥16 years) with isolated moderate-to-severe TBI (Abbreviated Injury Scale [AIS] Head≥3, AIS Body<3 and maximum 1 AIS Body=2). Patient characteristics and care pathways were compared across transfer status strata. A generalized additive model was developed using purposeful selection to identify factors associated with transfer and how they affected transfer probability. <p>Results The study included 1735 patients admitted to acute care trauma hospitals, of whom 692 (40%) were transferred to neurotrauma centers. Transferred patients were younger (median 60 vs. 72 years, P<0.001), more severely injured (median New Injury Severity Score [NISS]: 29 vs. 17, P<0.001), and had lower admission Glasgow Coma Scale (GCS) scores (≤13: 55% vs. 27, P<0.001). Increased transfer probability was significantly associated with reduced GCS scores, comorbidity in patients<77 years, and increasing NISSs until the effect was inverted at higher scores. Decreased transfer probability was significantly associated with increasing age and comorbidity, and distance between the acute care trauma hospital and the nearest neurotrauma center, except for extreme NISSs. <p>Conclusions Acute care trauma hospitals managed a substantial burden of isolated moderate-to-severe TBI patients primarily and definitively, highlighting the importance of high-quality neurotrauma care in non-neurosurgical hospitals. The transfer probability declined with increasing age and comorbidity, suggesting that older patients were carefully selected for transfer to specialized care.

• Riemann, Lennart; Mikolic, Ana; Maas, Andrew; Unterberg, Andreas; Younsi, Alexander & Åkerlund, Cecilia [Show all 67 contributors for this article] (2023). Computed Tomography Lesions and Their Association With Global Outcome in Young People With Mild Traumatic Brain Injury. Journal of Neurotrauma. ISSN 0897-7151. 40(11-12), p. 1243–1254. doi: 10.1089/neu.2022.0055. Full text in Research Archive Show summary

  Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13–15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a “positive CT” (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17–22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24–0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25–0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care.

• Woodrow, Rebecca E; Winzeck, Stefan; Luppi, Andrea I; Kelleher-Unger, Isaac R; Spindler, Lennart R B & Wilson, J T Lindsay [Show all 86 contributors for this article] (2023). Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury. Brain. ISSN 0006-8950. 146(8), p. 3484–3499. doi: 10.1093/brain/awad056. Full text in Research Archive Show summary

  Chronic post-concussive symptoms are common after mild traumatic brain injury (mTBI) and are difficult to predict or treat. Thalamic functional integrity is particularly vulnerable in mTBI and may be related to long-term outcomes but requires further investigation. We compared structural MRI and resting state functional MRI in 108 patients with a Glasgow Coma Scale (GCS) of 13–15 and normal CT, and 76 controls. We examined whether acute changes in thalamic functional connectivity were early markers for persistent symptoms and explored neurochemical associations of our findings using PET data. Of the mTBI cohort, 47% showed incomplete recovery 6 months post-injury. Despite the absence of structural changes, we found acute thalamic hyperconnectivity in mTBI, with specific vulnerabilities of individual thalamic nuclei. Acute fMRI markers differentiated those with chronic post-concussive symptoms, with time- and outcome-dependent relationships in a sub-cohort followed longitudinally. Moreover, emotional and cog

• Åkerlund, Cecilia A. I.; Holst, Anders; Bhattacharyay, Shubhayu; Stocchetti, Nino; Steyerberg, Ewout & Smielewski, Peter [Show all 111 contributors for this article] (2023). Clinical descriptors of disease trajectories in patients with traumatic brain injury in the intensive care unit (CENTER-TBI): a multicentre observational cohort study. Lancet Neurology. ISSN 1474-4422. 1, p. 71–80. doi: 10.1016/S1474-4422(23)00358-7. Full text in Research Archive Show summary

  Background Patients with traumatic brain injury are a heterogeneous population, and the most severely injured individuals are often treated in an intensive care unit (ICU). The primary injury at impact, and the harmful secondary events that can occur during the first week of the ICU stay, will affect outcome in this vulnerable group of patients. We aimed to identify clinical variables that might distinguish disease trajectories among patients with traumatic brain injury admitted to the ICU. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. We included patients aged 18 years or older with traumatic brain injury who were admitted to the ICU at one of the 65 CENTER-TBI participating centres, which range from large academic hospitals to small rural hospitals. For every patient, we obtained pre-injury data and injury features, clinical characteristics on admission, demographics, physiological param

• Netteland, Dag Ferner; Aarhus, Mads; Smistad, Erik; Sandset, Else Charlotte; Padayachy, Llewellyn & Helseth, Eirik [Show all 7 contributors for this article] (2023). Noninvasive intracranial pressure assessment by optic nerve sheath diameter: Automated measurements as an alternative to clinician-performed measurements. Frontiers in Neurology. 14. doi: 10.3389/fneur.2023.1064492. Full text in Research Archive Show summary

  Introduction Optic nerve sheath diameter (ONSD) has shown promise as a noninvasive parameter for estimating intracranial pressure (ICP). In this study, we evaluated a novel automated method of measuring the ONSD in transorbital ultrasound imaging. Methods From adult traumatic brain injury (TBI) patients with invasive ICP monitoring, bedside manual ONSD measurements and ultrasound videos of the optic nerve sheath complex were simultaneously acquired. Automatic ONSD measurements were obtained by the processing of the ultrasound videos by a novel software based on a machine learning approach for segmentation of the optic nerve sheath. Agreement between manual and automated measurements, as well as their correlation to invasive ICP, was evaluated. Furthermore, the ability to distinguish dichotomized ICP for manual and automatic measurements of ONSD was compared, both for ICP dichotomized at ≥20 mmHg and at the 50th percentile (≥14 mmHg). Finally, we performed an exploratory subgroup analysis based on the software's judgment of optic nerve axis alignment to elucidate the reasons for variation in the agreement between automatic and manual measurements. Results A total of 43 ultrasound examinations were performed on 25 adult patients with TBI, resulting in 86 image sequences covering the right and left eyes. The median pairwise difference between automatically and manually measured ONSD was 0.06 mm (IQR −0.44 to 0.38 mm; p = 0.80). The manually measured ONSD showed a positive correlation with ICP, while automatically measured ONSD showed a trend toward, but not a statistically significant correlation with ICP. When examining the ability to distinguish dichotomized ICP, manual and automatic measurements performed with similar accuracy both for an ICP cutoff at 20 mmHg (manual: AUC 0.74, 95% CI 0.58–0.88; automatic: AUC 0.83, 95% CI 0.66–0.93) and for an ICP cutoff at 14 mmHg (manual: AUC 0.70, 95% CI 0.52–0.85; automatic: AUC 0.68, 95% CI 0.48–0.83). In the exploratory subgroup analysis, we found that the agreement between measurements was higher in the subgroup where the automatic software evaluated the optic nerve axis alignment as good as compared to intermediate/poor. Conclusion The novel automated method of measuring the ONSD on the ultrasound videos using segmentation of the optic nerve sheath showed a reasonable agreement with manual measurements and performed equally well in distinguishing high and low ICP.

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Søberg, Helene L. & Røise, Olav [Show all 15 contributors for this article] (2023). Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan. Journal of Rehabilitation Medicine. ISSN 1650-1977. 55. doi: 10.2340/jrm.v55.6552. Full text in Research Archive Show summary

  Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan.<p> <p>Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score >9. <p>Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. <p>Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma.

• Blakstad, Hanne Kristin; Mireles, Eduardo Erasmo Mendoza; Heggebø, Liv Cathrine; Magelssen, Henriette; Sprauten, Mette & Johannesen, Tom Børge [Show all 13 contributors for this article] (2023). Incidence and outcome of pseudoprogression after radiation therapy in glioblastoma patients: A cohort study. Neuro-Oncology Practice. ISSN 2054-2577. 11(1), p. 36–45. doi: 10.1093/nop/npad063. Full text in Research Archive
• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study. Injury Epidemiology. 10. doi: 10.1186/s40621-023-00431-y. Full text in Research Archive Show summary

  Background - Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries.<p> <p>Methods - A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020).<p> <p>Results - In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3–4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated.<p> <p>Conclusions - Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.

• Mireles, Eduardo Erasmo Mendoza; Skaga, Erlend; Server, Andrés; Leske, Henning; Brandal, Petter & Helseth, Eirik [Show all 8 contributors for this article] (2023). The benefit of complete resection of contrast enhancing tumor in glioblastoma patients: A population-based study. Neuro-Oncology Practice. ISSN 2054-2577. 10(6), p. 555–564. doi: 10.1093/nop/npad037. Full text in Research Archive Show summary

  Abstract Background New treatment modalities have not been widely adopted for patients with glioblastoma (GBM) after the addition of temozolomide to radiotherapy. We hypothesize that increased extent of resection (EOR) has resulted in improved survival for surgically treated patients with glioblastoma at the population level. Methods Retrospective analysis of adult patients operated for glioblastoma in the population of South–Eastern Norway. Patients were stratified into Pre-temozolomide- (2003–2005), temozolomide- (2006–2012), and resection-focused period (2013–2019) and evaluated according to age and EOR. Results The study included 1657 adult patients operated on for supratentorial glioblastoma. The incidence of histologically confirmed glioblastoma increased from 3.7 in 2003 to 5.3 per 100 000 in 2019. The median survival was 11.4 months. Complete resection of contrast-enhancing tumor (CRCET) was achieved in 386 patients, and this fraction increased from 13% to 32% across the periods. Significant improvement in median survival was found between the first 2 periods and the last (10.5 and 10.6 vs. 12.3 months; P &amp;lt; .01), with a significant increase in 3- and 5-year survival probability to 12% and 6% (P &amp;lt; .01). Patients with CRCET survived longer than patients with non-CRCET (16.1 vs. 10.8 months; P &amp;lt; .001). The median survival doubled in patients ≥70 years and (12.1 months). Survival was similar between the time periods in patients where CRCET was achieved. Conclusions We demonstrate an improved survival of GBM patients at the population level associated with an increased fraction of patients with CRCET. The data support the importance of CRCET to improve glioblastoma patient outcomes.

• Galteland, Pål; Næss, Ingar; Døving, Mats; Sehic, Amer; Utheim, Tor Paaske & Skaga, Nils Oddvar [Show all 9 contributors for this article] (2023). Facial Fractures and Their Relation to Head and Cervical Spine Injuries in Hospitalized Bicyclists. The Journal of craniofacial surgery (Print). ISSN 1049-2275. 34(1), p. 34–39. doi: 10.1097/SCS.0000000000009032. Full text in Research Archive
• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries. Journal of Clinical Medicine. 12(16). doi: 10.3390/jcm12165300. Full text in Research Archive Show summary

  This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.

• Bockhop, Fabian; Zeldovich, Marina; Cunitz, Katrin; Praag, Dominique Van; Vlegel, Marjolein van der & Beissbarth, Tim [Show all 258 contributors for this article] (2022). Measurement invariance of six language versions of the post-traumatic stress disorder checklist for DSM-5 in civilians after traumatic brain injury. Scientific Reports. 12(1), p. 1–15. doi: 10.1038/s41598-022-20170-2. Full text in Research Archive Show summary

  Traumatic brain injury (TBI) is frequently associated with neuropsychiatric impairments such as symptoms of post-traumatic stress disorder (PTSD), which can be screened using self-report instruments such as the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The current study aims to inspect the factorial validity and cross-linguistic equivalence of the PCL-5 in individuals after TBI with differential severity. Data for six language groups (n ≥ 200; Dutch, English, Finnish, Italian, Norwegian, Spanish) were extracted from the CENTER-TBI study database. Factorial validity of PTSD was evaluated using confirmatory factor analyses (CFA), and compared between four concurrent structural models. A multi-group CFA approach was utilized to investigate the measurement invariance (MI) of the PCL-5 across languages. All structural models showed satisfactory goodness-of-fit with small between-model variation. The original DSM-5 model for PTSD provided solid evidence of MI across the language groups. The current study underlines the validity of the clinical DSM-5 conceptualization of PTSD and demonstrates the comparability of PCL-5 symptom scores between language versions in individuals after TBI. Future studies should apply MI methods to other sociodemographic (e.g., age, gender) and injury-related (e.g., TBI severity) characteristics to improve the monitoring and clinical care of individuals suffering from PTSD symptoms after TBI.

• Utheim, Nils Christian; Helseth, Eirik; Strøm, Mona; Rydning, pål Nicolay; Mejlænder-Evjensvold, Magnus & Glott, Thomas [Show all 10 contributors for this article] (2022). Epidemiology of traumatic cervical spinal fractures in a general Norwegian population. Injury Epidemiology. 9(10). doi: 10.1186/s40621-022-00374-w. Full text in Research Archive Show summary

  Background: In Western countries, the typical cervical spine fracture (CS‑Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contempo‑ rary population‑based epidemiological data of traumatic CS‑Fx for use in health‑care planning and injury prevention. Methods: This is a population‑based retrospective database study (with prospectively collected data) from the Southeast Norway health region with 3.0 million inhabitants. We included all consecutive cases diagnosed with a CS‑Fx between 2015 and 2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented. Results: We registered 2153 consecutive cases with CS‑Fx during a 5‑year period, with an overall crude incidence of CS‑Fx of 14.9/100,000 person‑years. Age‑adjusted incidences using the standard population for Europe and the World was 15.6/100,000 person‑years and 10.4/100,000 person‑years, respectively. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%), and four‑wheel motorized vehicle accidents (10%). The most common upper CS‑Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person‑years surgery rate), and no stabilization in 9%. The overall 90‑day mortality was 153/2153 (7.1%). Conclusions: This study provides an overview of the extent of the issue and patient complexity necessary for plan‑ ning the health‑care management and injury prevention of CS‑Fx. The typical CS‑Fx patient was an elderly male or female with significant comorbidities injured in a low‑energy trauma. The overall crude incidences of CS‑Fx and surgi‑ cal fixation of CS‑Fx in Southeast Norway were 14.9/100,000 person‑years and 3.7/100,000 person‑years, respectively. Keywords: Spinal fracture, Spinal cord injury, Cervical, Traumatic, Epidemiology, Population‑based

• Wilson, Lindsay; Horton, Lindsay; Polinder, Suzanne; Newcombe, Virginia F.J.; Steinbuechel, Nicole v. & Maas, Andrew I. R. [Show all 50 contributors for this article] (2022). Tailoring Multi-Dimensional Outcomes to Level of Functional Recovery after Traumatic Brain Injury. Journal of Neurotrauma. ISSN 0897-7151. 39(19-20), p. 1363–1381. doi: 10.1089/neu.2022.0013. Full text in Research Archive Show summary

  There is increasing emphasis on assessing multi-dimensional outcomes in traumatic brain injury (TBI), but achieving this aim is hampered by a plethora of overlapping assessment tools. There is a clear need for advice on the choice of outcomes and we examined level of functional recovery as a framework to guide selection of assessments. In this cohort study we analysed cross-sectional data from 2604 patients enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project. Patients were followed up 6 months after injury and assessed on the Glasgow Outcome Scale-Extended (GOSE), cognitive tests, and patient-reported outcomes. We describe assessment completeness and prevalence of impairment. Relationships between outcomes were visualized using UpSet plots and hierarchical cluster analysis. GOSE categories varied markedly for both completion rates, 34–91% for patient-reported outcomes and 9–81% for cognitive tests, and prevalence of impairment, 3–82% for patient-reported outcomes and 9–59% for cognitive tests. In complete case samples, the GOSE identified impairment in 59–61%, whereas the most impaired patient-reported outcome was the Short Form-12 version 2 (SF-12v2) Physical Component Summary (28% overall), and the most impaired cognitive test was Trail Making Test (TMT) Part A (19% overall). The findings show that degree of disability is a key context of use for cognitive tests and patient-reported outcomes. Level of functional recovery provides a guide to the feasibility of different types of assessment and the likelihood of impairment, and can help tailor suitable assessment approaches in clinical practice and research studies.

• Eng, Svend Filip; Næss, Ingar; Linnerud, Hege; Rønning, Pål Andre; Brommeland, Tor & Mejlænder-Evjensvold, Magnus [Show all 12 contributors for this article] (2022). Bicycle-related cervical spine injuries. North American Spine Society Journal (NASSJ). 10. doi: 10.1016/j.xnsj.2022.100119. Full text in Research Archive
• Gheorghiu, Ana; Brunborg, Cathrine; Johannessen, Tom Børge; Helseth, Eirik; Zwart, John Anker Henrik & Wiedmann, Markus (2022). The impact of body mass index and height on risk for primary tumours of the spinal cord, spinal meninges, spinal and peripheral nerves in 1.7 million norwegian women and men: a prospective cohort study. Acta Oncologica. ISSN 0284-186X. 61(1), p. 1–6. doi: 10.1080/0284186X.2021.2009562. Full text in Research Archive Show summary

  Background Primary tumours of the spinal cord, spinal meninges, spinal and peripheral nerves comprise a heterogenous group of pathology, dominantly represented by meningioma, nerve sheath tumours (NST) and glioma. Body height and body mass index (BMI) are risk factors for certain brain tumour subgroups, but no other study has specifically assessed height and BMI in relation to primary tumours of the spine and peripheral nerves in women and men. Methods In this prospective population-based cohort study height and weight were measured in 1.7 million adult Norwegian women and men at baseline. Incident cases of primary tumours arising from the spinal cord, spinal meninges, spinal and peripheral nerves during follow-up were identified by linkage to the National Cancer Registry. Tumour risk was assessed by Cox regression analyses in relation to height and BMI. Results During 49 million person-years of follow-up, 857 primary tumours of the spinal cord, spinal meninges, spinal and peripheral nerves were identified. Overweight and obesity were not associated with risk for all tumours or any tumour subgroup. Height was positively associated with risk for all tumours (HR per 10 cm increase: 1.30, 95% CI 1.16–1.46). The association between height and tumour risk varied between tumour subgroups: while height was not significantly associated with NST, height increased the risk for meningioma (HR 1.42, 95% CI 1.13–1.78) and glioma (HR 1.56, 95% CI 1.06–2.28). The strongest association between height and tumour risk was found for the glioma subgroup of ependymoma in women (HR 3.38, 95% CI 1.64–6.94). Conclusion This study could not identify overweight and obesity as risk factors for primary tumours of the spinal cord, spinal meninges, spinal and peripheral nerves in women or men. Increasing body height was associated with increased tumour risk overall, but not universal for all tumour subgroups. Importance of the study Primary tumours of the spinal cord, spinal meninges, spinal and peripheral nerves have received little focus in epidemiologic studies, although the incidence and histo-pathological tumour subgroups differ significantly from primary brain tumours. Risk factors for these tumours have hardly been assessed in previous studies. Height, overweight and obesity are known risk factors for several cancers, including certain brain tumour subgroups, such as meningioma. This is the first study to report the association between height, overweight and obesity and primary tumours of the spinal cord, spinal meninges, spinal and peripheral nerves. This includes tumour subgroups of meningioma, nerve sheath tumour, glioma and the most common spinal glioma subgroup of ependymoma. While overweight and obesity were not associated with either of the tumour subgroups, an association between increasing body height and risk for spinal meningioma and glioma, including ependymoma, was found. Nerve sheath tumour risk was not associated with increasing body height.

• Praag, Dominique L.G. Van; Wouters, Kristien; Eede, Filip Van Den; Wilson, Lindsay; Maas, Andrew I.R. & Åkerlund, Cecilia [Show all 250 contributors for this article] (2022). Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury. Brain and Spine. 2. doi: 10.1016/j.bas.2021.100854. Full text in Research Archive
• Sørensen, Petter Toivo; Nyborg, Geir; Lorentsen, Torleif; Olasveengen, Theresa M.; Langerud, Anne Kathrine & Aarhus, Mads [Show all 9 contributors for this article] (2022). Vasospasm Surveillance by a Simplified Transcranial Doppler Protocol in Traumatic Brain Injury. World Neurosurgery. ISSN 1878-8750. 164, p. e318–e325. doi: 10.1016/j.wneu.2022.04.108. Full text in Research Archive Show summary

  Objective To detect post-traumatic vasospasm in patients with traumatic brain injury (TBI), we implemented a simplified transcranial Doppler (TCD) surveillance protocol in a neurointensive care setting. In this study, we evaluate the yield of this protocol. Methods Adult patients with TBI admitted to the neurointensive care unit were examined with TCD by 2 intensive care nurses trained in TCD examinations. Flow velocities of the middle cerebral arteries were recorded. TCD suspected vasospasm was defined as the mean flow velocity >120 cm/s, and when detected, the protocol recommended a supplementary computed tomography angiography. The rate of detection of TCD suspected vasospasm and the subsequent rate of radiological diagnosis of vasospasm were recorded. In multivariate logistic regression analysis, we evaluated age, initial Glasgow Coma Scale, craniotomy, and decompressive craniectomy as potential predictors of developing increased TCD velocity. Results A total of 84 patients with TBI with a median initial Glasgow Coma Scale score of 6 were examined by TCD. TCD suspected vasospasm was found in the middle cerebral arteries of 18% of examined patients. Two-thirds of patients with TCD suspected vasospasm were investigated with a subsequent computed tomography angiography, and 80% of these patients received a radiological diagnosis of vasospasm. In logistic regression analysis, decompressive craniectomy was significantly associated with increased risk of developing TCD suspected vasospasm (odds ratio: 11.57, 95% confidence interval: 2.59–51.73, P = 0.001). Conclusions The implementation of a simplified TCD surveillance protocol in a neurointensive care setting yielded an 18% detection rate of TCD suspected vasospasm. In our cohort of patients with TBI, decompressive craniectomy was associated with increased risk of developing TCD suspected vasospasm.

• Døving, Mats; Næss, Ingar; Galteland, Pål; Ramm-Pettersen, Jon-Terje; Dalby, Marius & Utheim, Tor Paaske [Show all 9 contributors for this article] (2022). Anatomical distribution of mandibular fractures from severe bicycling accidents: A 12-year experience from a Norwegian level 1 trauma center. Dental Traumatology. ISSN 1600-4469. 38(5), p. 424–430. doi: 10.1111/edt.12756. Full text in Research Archive Show summary

  Background/Aim The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible because conventional helmets provide little protection to the lower part of the face. In addition, some studies indicate that helmets may lead to an increased risk of mandibular fractures. Thus, the aim of this study was to examine the anatomic distribution of mandibular fractures in injured cyclists and to assess if helmet use influenced the fracture locations. Material and Methods Data from a Norwegian Level 1 trauma center were collected in the Oslo University Hospital Trauma Registry over a 12-year period. Of 1543 injured cyclists, the electronic patient charts of 62 cyclists with fractures of the mandible were retrospectively evaluated in detail. Demographic data, helmet use, and fracture type were assessed. Results Sixty-two patients (4%) had fractures of the mandible, and women had an increased risk (OR 2.49, 95% CI 1.49–4.16, p < .001). The most common fracture site was the mandibular body, followed by the condyle. Isolated mandibular fractures occurred in 45% of the patients and 55% had other concomitant facial fractures. There were 42% of the patients with fractures in multiple sites of the mandible, and 42% had a concomitant dentoalveolar injury. Half of the cyclists were wearing a helmet at the time of the accident and 39% were not. There was no significant difference in fracture distribution between the helmeted and non-helmeted groups. Conclusions Fracture of the mandibular body was the most prevalent mandibular fracture type following bicycle accidents. Women had an increased risk of mandibular fractures compared with men, whereas helmet wearing did not affect the anatomical fracture site.

• Thomas, Ilias; Dickens, Alex M.; Posti, Jussi P.; Czeiter, Endre; Duberg, Daniel & Sinioja, Tim [Show all 255 contributors for this article] (2022). Serum metabolome associated with severity of acute traumatic brain injury. Nature Communications. 13(1), p. 1–15. doi: 10.1038/s41467-022-30227-5. Full text in Research Archive Show summary

  Complex metabolic disruption is a crucial aspect of the pathophysiology of traumatic brain injury (TBI). Associations between this and systemic metabolism and their potential prognostic value are poorly understood. Here, we aimed to describe the serum metabolome (including lipidome) associated with acute TBI within 24 h post-injury, and its relationship to severity of injury and patient outcome. We performed a comprehensive metabolomics study in a cohort of 716 patients with TBI and non-TBI reference patients (orthopedic, internal medicine, and other neurological patients) from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We identified panels of metabolites specifically associated with TBI severity and patient outcomes. Choline phospholipids (lysophosphatidylcholines, ether phosphatidylcholines and sphingomyelins) were inversely associated with TBI severity and were among the strongest predictors of TBI patient outcomes, which was further confirmed in a separate validation dataset of 558 patients. The observed metabolic patterns may reflect different pathophysiological mechanisms, including protective changes of systemic lipid metabolism aiming to maintain lipid homeostasis in the brain.

• Vlegel, Marjolein van der; Mikolić, Ana; Hee, Quentin Lee; Kaplan, Z.L. Rana; Helmrich, Isabel R.A. Retel & Veen, Ernest van [Show all 255 contributors for this article] (2022). Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study. Injury. ISSN 0020-1383. 53(8), p. 2774–2782. doi: 10.1016/j.injury.2022.05.009. Full text in Research Archive Show summary

  Introduction The incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI. Methods We used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury. Results Of 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms. Conclusion The rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.

• Løke, Daniel; Andelic, Nada; Helseth, Eirik; Vassend, Olav Mandt; Andersson, Stein & Ponsford, Jennie [Show all 9 contributors for this article] (2022). Stability and Change in Biopsychosocial Factors Associated With Fatigue 6 and 12 Months After Traumatic Brain Injury: An Exploratory Multilevel Study. The journal of head trauma rehabilitation. ISSN 0885-9701. 38(4). doi: 10.1097/HTR.0000000000000847. Full text in Research Archive
• Howe, Emilie; Zeldovich, Marina; Andelic, Nada; Steinbuechel, Nicole von; Fure, Silje Christine Reistad & Borgen, Ida Maria Henriksen [Show all 51 contributors for this article] (2022). Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study. BMC Health Services Research. 22(1), p. 1–16. doi: 10.1186/s12913-022-08908-0. Full text in Research Archive Show summary

  Background Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall

• Tverdal, Cathrine Buaas; Brunborg, Cathrine; Helseth, Eirik; Andelic, Nada; Koch, Marte Ellersgaard & Røe, Cecilie [Show all 8 contributors for this article] (2022). Referrals to early specialized rehabilitation after traumatic brain iinjury during the Covid-19 pandemic. Journal of Rehabilitation Medicine. ISSN 1650-1977. 54:jrm00334, p. 1–9. doi: 10.2340/jrm.v54.2203. Full text in Research Archive Show summary

  Objective: To quantify potential changes in direct referral to early specialized rehabilitation during the COVID-19 pandemic and the injury pattern of patients hospitalized with traumatic brain injury (TBI) at a level 1 trauma centre.Methods: In this registry-based study, data were retrieved from the Oslo TBI Registry-Neurosurgery and included adult patients with injury-related intracranial findings admitted to Oslo University Hospital (OUH). The study focused on a period of time when OUH was in any level of preparedness because of the COVID-19 pandemic; March 2020 to August 2021. For comparison, the study used patients hospitalized for TBI in 2018 and 2019.Results: A total of 1,310 hospitalized patients with TBI were divided into 2 groups; pre-pandemic and pandemic. Direct referral to early rehabilitation was maintained. Patient volume remained stable, and there were no differences between the groups regarding patient characteristics and acute management, although there was a significantly higher proportion of TBIs secondary to electric scooter accidents in the pandemic group. Results from univariable and multivariable logistic regression showed a multifaceted reality, but younger age, none or mild preinjury comorbidity and severe disability due to TBI at discharge from acute care remained stable strong predictors of direct referral to rehabilitation.Conclusion: For patients with moderate-severe TBI, the direct pathway to early specialized rehabilitation was maintained during 2020–21. However, the pandemic continued and the long-term impact for rehabilitation services is not yet known. LAY ABSTRACTAfter traumatic brain injury, early rehabilitation is important in order to achieve optimal functional outcome. The COVID-19 pandemic has put the health services under pressure, and hospitals in Norway were reorganized to be able to treat a large number of patients with COVID-19. Therefore, this study investigated to what extent the transfer to early rehabilitation has been affected and whether there have been changes in volume and characteristics of patients admitted to hospital with traumatic brain injury. In conclusion, the direct pathway to early rehabilitation was maintained during the pandemic years 2020 and 2021. Moreover, there was no change in the number of hospital admissions or patient characteristics, and acute management was maintained. However, the true long-term consequences for rehabilitation are not yet known.

• Hellstrøm, Torgeir; Andelic, Nada; Holthe, Øyvor; Helseth, Eirik; Server, Andrés & Eiklid, Kristin Louise [Show all 7 contributors for this article] (2022). APOE-ε4 Is Associated With Reduced Verbal Memory Performance and Higher Emotional, Cognitive, and Everyday Executive Function Symptoms Two Months After Mild Traumatic Brain Injury. Frontiers in Neurology. 13, p. 1–9. doi: 10.3389/fneur.2022.735206. Full text in Research Archive Show summary

  Background Substantial variance exists in outcomes after mild traumatic brain injury (MTBI), and these differences are not fully explained by injury characteristics or severity. Genetic factors are likely to play a role in this variance. Objectives The aim of this study was to examine associations between the apolipoprotein (APOE)-ε4 allele and memory measures at two months post-MTBI and to evaluate whether subjective cognitive and affective symptoms were associated with APOE-ε4 status. Based on previous research, it was hypothesized that APOE-ε4 carriers would show poorer verbal memory performance compared to APOE-ε4 non-carriers. Methods Neuropsychological data at two months post-injury and blood samples that could be used to assess APOE genotype were available for 134 patients with MTBI (mean age 39.2 years, 62% males, 37% APOE-ε4 carriers). All patients underwent computed tomography at hospital admission and magnetic resonance imaging four weeks post-injury. Results The APOE-ε4 + status was associated with decreased immediate memory recall ( p = 0.036; β = −0.10, 95% CI [−0.19, −0.01]). Emotional, cognitive, and everyday executive function symptoms at two months post-injury were significantly higher in APOE-ε4 carriers compared to non-carriers. Conclusion The APOE-ε4+ allele has a negative effect on verbal memory and symptom burden two months after MTBI.

• Sødal, Hild Flatmark; Storvig, Gøril; Tverdal, Cathrine Buaas; Robinson, Hilde Stendal; Helseth, Eirik & Taubøll, Erik (2022). Early post-traumatic seizures in hospitalized patients with traumatic brain injury. Acta Neurologica Scandinavica. ISSN 0001-6314. 146(5), p. 485–491. doi: 10.1111/ane.13670. Full text in Research Archive Show summary

  Objectives Early post-traumatic seizures (EPTS) are a well-known complication of traumatic brain injury (TBI). EPTS increase the risk of secondary brain injury and may cause significant challenges during the period of critical care. Routine use of prophylactic anti-seizure medication is controversial due to conflicting reports on efficacy and risk of adverse effects. The purpose of this study was to expand the understanding of EPTS by examining incidence and risk factors in hospitalized patients with TBI. Material & Methods Adult patients with TBI and evidence of intracranial injury admitted to Oslo University Hospital between 2015 and 2019 were identified from the Oslo TBI Registry - Neurosurgery. Demographic and clinical data including occurrence of seizures were retrieved from the registry. The patients did not receive routine seizure prophylaxis. Univariate and multivariable logistic regression analyses were used to investigate risk factors associated with EPTS. Results 103 of 1827 patients (5.6%) had new-onset seizures within the first week after TBI. The following factors were in multivariable analyses associated with EPTS; alcohol abuse (odds ratio [OR] 3.6, 95% CI 2.3–5.7, p < .001), moderate and severe brain injury (OR 2.2, 95% CI 1.3–3.8, p = .004 and OR 2.1, 95% CI 1.2–3.6, p = .012), brain contusion (OR 1.6, 95% CI 1.0–2.4, p = .046) and subdural hematoma (OR 1.6, 95% CI 1.0–2.6, p = .052). Conclusion In our material, EPTS occurred in 5.6% of hospital-admitted TBI-patients. Alcohol abuse was the most significant risk factor, followed by moderate and severe brain injury. The results of this study contribute to the discussion about preventive treatment of EPTS in certain risk groups.

• Tverdal, Cathrine Buaas; Aarhus, Mads; Rønning, Pål Andre; Skaansar, Ola Fougner; Skogen, Karoline & Andelic, Nada [Show all 7 contributors for this article] (2022). Incidence of emergency neurosurgical TBI procedures: a population-based study. BMC Emergency Medicine. 22(1), p. 1–11. doi: 10.1186/s12873-021-00561-w. Full text in Research Archive Show summary

  Background The rates of emergency neurosurgery in traumatic brain injury (TBI) patients vary between populations and trauma centers. In planning acute TBI treatment, knowledge about rates and incidence of emergency neurosurgery at the population level is of importance for organization and planning of specialized health care services. This study aimed to present incidence rates and patient characteristics for the most common TBI-related emergency neurosurgical procedures. Methods Oslo University Hospital is the only trauma center with neurosurgical services in Southeast Norway, which has a population of 3 million. We extracted prospectively collected registry data from the Oslo TBI Registry – Neurosurgery over a five-year period (2015–2019). Incidence was calculated in person-pears (crude) and age-adjusted for standard population. We conducted multivariate multivariable logistic regression models to assess variables associated with emergency neurosurgical procedures. Results A total of 2151 patients with pathological head CT scans were included. One or more emergency neurosurgical procedure was performed in 27% of patients. The crude incidence was 3.9/100,000 person-years. The age-adjusted incidences in the standard population for Europe and the world were 4.0/100,000 and 3.3/100,000, respectively. The most frequent emergency neurosurgical procedure was the insertion of an intracranial pressure monitor, followed by evacuation of the mass lesion. Male sex, road traffic accidents, severe injury (low Glasgow coma score) and CT characteristics such as midline shift and compressed/absent basal cisterns were significantly associated with an increased probability of emergency neurosurgery, while older age was associated with a decreased probability. Conclusions The incidence of emergency neurosurgery in the general population is low and reflects neurosurgery procedures performed in patients with severe injuries. Hence, emergency neurosurgery for TBIs should be centralized to major trauma centers.

• Tønne, Elin; Due-Tønnessen, Bernt Johan; Vigeland, Magnus Dehli; Amundsen, Silja Svanstrøm; Ribarska, Teodora Plamenova & Åsten, Pamela [Show all 11 contributors for this article] (2022). Whole-exome sequencing in syndromic craniosynostosis increases diagnostic yield and identifies candidate genes in osteogenic signaling pathways. American Journal of Medical Genetics. Part A. ISSN 1552-4825. 188A(5), p. 1464–1475. doi: 10.1002/ajmg.a.62663. Full text in Research Archive Show summary

  Craniosynostosis (CS) is a common congenital anomaly defined by premature fusionof one or more cranial sutures. Syndromic CS involves additional organ anomalies orneurocognitive deficits and accounts for 25%–30% of the cases. In a recentpopulation-based study by our group, 84% of the syndromic CS cases had a geneti-cally verified diagnosis after targeted analyses. A number of different genetic causeswere detected, confirming that syndromic CS is highly heterogeneous. In this study,we performed whole-exome sequencing of 10 children and parents from the samecohort where previous genetic results were negative. We detected pathogenic, orlikely pathogenic, variants in four additional genes (NFIA,EXTL3,POLR2A, andFOXP2)associated with rare conditions. In two of these (POLR2AandFOXP2), CS has notpreviously been reported. We further detected a rare predicted damaging variant inSH3BP4, which has not previously been related to human disease. All findings wereclustered in genes involved in the pathways of osteogenesis and suture patency.Weconclude that whole-exome sequencing expands the list of genes associated withsyndromic CS, and provides new candidate genes in osteogenic signaling pathways.

• Stray, August Vincent; SIVERTS, HENRIK; Melhuus, Knut; Enger, Martine Merete; Galteland, Pål & Næss, Ingar [Show all 8 contributors for this article] (2022). Characteristics of Electric Scooter and Bicycle Injuries After Introduction of Electric Scooter Rentals in Oslo, Norway. JAMA Network Open. p. E2226701–E2226701. doi: 10.1001/jamanetworkopen.2022.26701. Full text in Research Archive
• Rootwelt, Rebecca; Hjermstad, Marianne Jensen; Skovlund, Eva; Aass, Nina Kathrine; Helseth, Eirik & Kaasa, Stein [Show all 8 contributors for this article] (2022). Surgery for brain metastases—impact of the extent of resection. Acta Neurochirurgica. ISSN 0001-6268. 164, p. 2773–2780. doi: 10.1007/s00701-021-05104-7. Full text in Research Archive Show summary

  Background Surgical resection of brain metastases improves symptoms and survival in selected patients. The benefit of gross total resection is disputed, as most patients are believed to succumb from their non-CNS tumor burden. We investigated the association between overall survival and residual tumor after surgery for single brain metastases. Methods We reviewed adults who underwent surgery for a single brain metastasis at a regional referral center (2011–2018). Gross total resection was defined as no visible residual tumor on cerebral MRI 12–48 h postoperatively. Results We included 373 patients. The most common primary tumors were lung cancer (36%) and melanoma (24%). We identified gross total resection in 238 patients (64%). Median overall survival was 11.0 months, 8.0 (6.2–9.8) months for patients with subtotal resection and 13.0 (9.7–16.3) months for patients with gross total resection. In a multivariate regression analysis including preoperative prognostic factors, gross total resection was associated with longer overall survival (HR: 0.66, p = 0.003). Postoperative radiotherapy administered within 6 weeks did not significantly alter the hazard ratio estimates for grade of resection. Conclusions Our study suggests improved survival with gross total resection compared to subtotal resection. The importance of extent of resection in surgery for brain metastases should not be discarded.

• Maas, Andrew I. R.; Menon, David K.; Manley, Geoffrey; Abrams, Mathew; Åkerlund, Cecilia & Andelic, Nada [Show all 50 contributors for this article] (2022). Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurology. ISSN 1474-4422. 21(11), p. 1004–1060. doi: 10.1016/S1474-4422(22)00309-X. Full text in Research Archive
• Rezoagli, Emanuele; Petrosino, Matteo; Rebora, Paola; Menon, David K.; Mondello, Stefania & Cooper, D. James [Show all 50 contributors for this article] (2022). High arterial oxygen levels and supplemental oxygen administration in traumatic brain injury: insights from CENTER-TBI and OzENTER-TBI. Intensive Care Medicine. ISSN 0342-4642. 48, p. 1709–1725. doi: 10.1007/s00134-022-06884-x. Full text in Research Archive Show summary

  Purpose The effect of high arterial oxygen levels and supplemental oxygen administration on outcomes in traumatic brain injury (TBI) is debated, and data from large cohorts of TBI patients are limited. We investigated whether exposure to high blood oxygen levels and high oxygen supplementation is independently associated with outcomes in TBI patients admitted to the intensive care unit (ICU) and undergoing mechanical ventilation. Methods This is a secondary analysis of two multicenter, prospective, observational, cohort studies performed in Europe and Australia. In TBI patients admitted to ICU, we describe the arterial partial pressure of oxygen (PaO2) and the oxygen inspired fraction (FiO2). We explored the association between high PaO2 and FiO2 levels within the first week with clinical outcomes. Furthermore, in the CENTER-TBI cohort, we investigate whether PaO2 and FiO2 levels may have differential relationships with outcome in the presence of varying levels of brain injury severity (as quantified by levels of glial fibrillary acidic protein (GFAP) in blood samples obtained within 24 h of injury). Results The analysis included 1084 patients (11,577 measurements) in the CENTER-TBI cohort, of whom 55% had an unfavorable outcome, and 26% died at a 6-month follow-up. Median PaO2 ranged from 93 to 166 mmHg. Exposure to higher PaO2 and FiO2 in the first seven days after ICU admission was independently associated with a higher mortality rate. A trend of a higher mortality rate was partially confirmed in the OzENTER-TBI cohort (n = 159). GFAP was independently associated with mortality and functional neurologic outcome at follow-up, but it did not modulate the outcome impact of high PaO2 and FiO2 levels, which remained independently associated with 6-month mortality. Conclusions In two large prospective multicenter cohorts of critically ill patients with TBI, levels of PaO2 and FiO2 varied widely across centers during the first seven days after ICU admission. Exposure to high arterial blood oxygen or high supplemental oxygen was independently associated with 6-month mortality in the CENTER-TBI cohort, and the severity of brain injury did not modulate this relationship. Due to the limited sample size, the findings were not wholly validated in the external OzENTER-TBI cohort. We cannot exclude the possibility that the worse outcomes associated with higher PaO2 were due to use of higher FiO2 in patients with more severe injury or physiological compromise. Further, these findings may not apply to patients in whom FiO2 and PaO2 are titrated to brain tissue oxygen monitoring (PbtO2) levels. However, at minimum, these findings support the need for caution with oxygen therapy in TBI, particularly since titration of supplemental oxygen is immediately applicable at the bedside.

• Essen, Thomas Van; Lingsma, Hester F; Pisică, Dana; Singh, Ranjit D.; Volovici, Victor & Boogert, Hugo F den [Show all 50 contributors for this article] (2022). Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study. Lancet Neurology. ISSN 1474-4422. 21(7), p. 620–631. doi: 10.1016/s1474-4422(22)00166-1. Full text in Research Archive Show summary

  Background Despite being well established, acute surgery in traumatic acute subdural haematoma is based on low-grade evidence. We aimed to compare the effectiveness of a strategy preferring acute surgical evacuation with one preferring initial conservative treatment in acute subdural haematoma. Methods We did a prospective, observational, comparative effectiveness study using data from participants enrolled in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We included patients with no pre-existing severe neurological disorders who presented with acute subdural haematoma within 24 h of traumatic brain injury. Using an instrumental variable analysis, we compared outcomes between centres according to treatment preference for acute subdural haematoma (acute surgical evacuation or initial conservative treatment), measured by the case-mix-adjusted percentage of acute surgery per centre. The primary endpoint was functional outcome at 6 months as rated with the Glasgow Outcome Scale Extended, which was estimated with ordinal regression as a common odds ratio (OR) and adjusted for prespecified confounders. Variation in centre preference was quantified with the median OR (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). Findings Between Dec 19, 2014 and Dec 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI, of whom 1407 (31%) presented with acute subdural haematoma and were included in our study. Acute surgical evacuation was done in 336 (24%) patients, by craniotomy in 245 (73%) of those patients and by decompressive craniectomy in 91 (27%). Delayed decompressive craniectomy or craniotomy after initial conservative treatment (n=982) occurred in 107 (11%) patients. The percentage of patients who underwent acute surgery ranged from 5·6% to 51·5% (IQR 12·3–35·9) between centres, with a two-times higher probability of receiving acute surgery for an identical patient in one centre versus another centre at random (adjusted MOR for acute surgery 1·8; p<0·0001]). Centre preference for acute surgery over initial conservative treatment was not associated with improvements in functional outcome (common OR per 23·6% [IQR increase] more acute surgery in a centre 0·92, 95% CI 0·77–1·09). Interpretation Our findings show that treatment for patients with acute subdural haematoma with similar characteristics differed depending on the treating centre, because of variation in the preferred approach. A treatment strategy preferring an aggressive approach of acute surgical evacuation over initial conservative treatment was not associated with better functional outcome. Therefore, in a patient with acute subdural haematoma for whom a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered. Funding The Hersenstichting Nederland (also known as the Dutch Brain Foundation), the European Commission Seventh Framework Programme, the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA), and NeuroTrauma Sciences (USA).

• Helmrich, Isabel Retel; Czeiter, Endre; Amrein, Krisztina; Büki, András; Lingsma, Hester F & Menon, David K [Show all 50 contributors for this article] (2022). Incremental prognostic value of acute serum biomarkers for functional outcome after traumatic brain injury (CENTER-TBI): an observational cohort study. Lancet Neurology. ISSN 1474-4422. 21(9), p. 792–802. doi: 10.1016/S1474-4422(22)00218-6. Full text in Research Archive Show summary

  Background Several studies have reported an association between serum biomarker values and functional outcome following traumatic brain injury. We aimed to examine the incremental (added) prognostic value of serum biomarkers over demographic, clinical, and radiological characteristics and over established prognostic models, such as IMPACT and CRASH, for prediction of functional outcome. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core study. We included patients aged 14 years or older who had blood sampling within 24 h of injury, results from a CT scan, and outcome assessment according to the Glasgow Outcome Scale-Extended (GOSE) at 6 months. Amounts in serum of six biomarkers (S100 calcium-binding protein B, neuron-specific enolase, glial fibrillary acidic protein, ubiquitin C-terminal hydrolase L1 [UCH-L1], neurofilament protein-light, and total tau) were measured. The incremental prognostic value of these biomarkers was determined separately and in combination. The primary outcome was the GOSE 6 months after injury. Incremental prognostic value, using proportional odds and a dichotomised analysis, was assessed by delta C-statistic and delta R2 between models with and without serum biomarkers, corrected for optimism with a bootstrapping procedure. Findings Serum biomarker values and 6-month GOSE were available for 2283 of 4509 patients. Higher biomarker levels were associated with worse outcome. Adding biomarkers improved the C-statistic by 0·014 (95% CI 0·009–0·020) and R2 by 4·9% (3·6–6·5) for predicting GOSE compared with demographic, clinical, and radiological characteristics. UCH-L1 had the greatest incremental prognostic value. Adding biomarkers to established prognostic models resulted in a relative increase in R2 of 48–65% for IMPACT and 30–34% for CRASH prognostic models. Interpretation Serum biomarkers have incremental prognostic value for functional outcome after traumatic brain injury. Our findings support integration of biomarkers—particularly UCH-L1—in established prognostic models. Funding European Union's Seventh Framework Programme, Hannelore Kohl Stiftung, OneMind, Integra LifeSciences, and NeuroTrauma Sciences

• Åkerlund, Cecilia; Holst, Anders; Stocchetti, Nino; Steyerberg, Ewout W; Menon, David K & Ercole, Ari [Show all 50 contributors for this article] (2022). Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study. Critical Care. ISSN 1364-8535. 26. doi: 10.1186/s13054-022-04079-w. Full text in Research Archive Show summary

  Background While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classification of traumatic brain injury (TBI) as ‘mild’, ‘moderate’ or ‘severe’ based on this fails to capture enormous heterogeneity in pathophysiology and treatment response. We hypothesized that data-driven characterization of TBI could identify distinct endotypes and give mechanistic insights. Methods We developed an unsupervised statistical clustering model based on a mixture of probabilistic graphs for presentation (< 24 h) demographic, clinical, physiological, laboratory and imaging data to identify subgroups of TBI patients admitted to the intensive care unit in the CENTER-TBI dataset (N = 1,728). A cluster similarity index was used for robust determination of optimal cluster number. Mutual information was used to quantify feature importance and for cluster interpretation. Results Six stable endotypes were identified with distinct GCS and composite systemic metabolic stress profiles, distinguished by GCS, blood lactate, oxygen saturation, serum creatinine, glucose, base excess, pH, arterial partial pressure of carbon dioxide, and body temperature. Notably, a cluster with ‘moderate’ TBI (by traditional classification) and deranged metabolic profile, had a worse outcome than a cluster with ‘severe’ GCS and a normal metabolic profile. Addition of cluster labels significantly improved the prognostic precision of the IMPACT (International Mission for Prognosis and Analysis of Clinical trials in TBI) extended model, for prediction of both unfavourable outcome and mortality (both p < 0.001). Conclusions Six stable and clinically distinct TBI endotypes were identified by probabilistic unsupervised clustering. In addition to presenting neurology, a profile of biochemical derangement was found to be an important distinguishing feature that was both biologically plausible and associated with outcome. Our work motivates refining current TBI classifications with factors describing metabolic stress. Such data-driven clusters suggest TBI endotypes that merit investigation to identify bespoke treatment strategies to improve care.

• Whitehouse, Daniel; Monteiro, Miguel; Czeiter, Endre; Vyvere, Thijs Vande; Valerio, Fernanda & Ye, Zheng [Show all 50 contributors for this article] (2022). Relationship of admission blood proteomic biomarkers levels to lesion type and lesion burden in traumatic brain injury: A CENTER-TBI study. EBioMedicine. 75, p. 1–15. doi: 10.1016/j.ebiom.2021.103777. Full text in Research Archive Show summary

  Background We aimed to understand the relationship between serum biomarker concentration and lesion type and volume found on computed tomography (CT) following all severities of TBI. Methods Concentrations of six serum biomarkers (GFAP, NFL, NSE, S100B, t-tau and UCH-L1) were measured in samples obtained <24 hours post-injury from 2869 patients with all severities of TBI, enrolled in the CENTER-TBI prospective cohort study (NCT02210221). Imaging phenotypes were defined as intraparenchymal haemorrhage (IPH), oedema, subdural haematoma (SDH), extradural haematoma (EDH), traumatic subarachnoid haemorrhage (tSAH), diffuse axonal injury (DAI), and intraventricular haemorrhage (IVH). Multivariable polynomial regression was performed to examine the association between biomarker levels and both distinct lesion types and lesion volumes. Hierarchical clustering was used to explore imaging phenotypes; and principal component analysis and k-means clustering of acute biomarker concentrations to explore patterns of biomarker clustering. Findings 2869 patient were included, 68% (n=1946) male with a median age of 49 years (range 2-96). All severities of TBI (mild, moderate and severe) were included for analysis with majority (n=1946, 68%) having a mild injury (GCS 13-15). Patients with severe diffuse injury (Marshall III/IV) showed significantly higher levels of all measured biomarkers, with the exception of NFL, than patients with focal mass lesions (Marshall grades V/VI). Patients with either DAI+IVH or SDH+IPH+tSAH, had significantly higher biomarker concentrations than patients with EDH. Higher biomarker concentrations were associated with greater volume of IPH (GFAP, S100B, t-tau;adj r2 range:0·48-0·49; p<0·05), oedema (GFAP, NFL, NSE, t-tau, UCH-L1;adj r2 range:0·44-0·44; p<0·01), IVH (S100B;adj r2 range:0.48-0.49; p<0.05), Unsupervised k-means biomarker clustering revealed two clusters explaining 83·9% of variance, with phenotyping characteristics related to clinical injury severity. Interpretation Interpretation: Biomarker concentration within 24 hours of TBI is primarily related to severity of injury and intracranial disease burden, rather than pathoanatomical type of injury. Funding CENTER-TBI is funded by the European Union 7th Framework programme (EC grant 602150).

• Rivera, Diego; Greving, Sven; Arango-Lasprilla, Juan Carlos; Steinbuechel, Nicole von; Zeldovich, Marina & Åkerlund, Cecilia [Show all 85 contributors for this article] (2022). Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study. Journal of Clinical Medicine. 11(14), p. 1–23. doi: 10.3390/jcm11144090. Full text in Research Archive Show summary

  settingsOrder Article Reprints Open AccessArticle Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study by Diego Rivera 1,2ORCID,Sven Greving 3,Juan Carlos Arango-Lasprilla 4ORCID,Nicole von Steinbuechel 3,Marina Zeldovich 3,*ORCID andCENTER-TBI Participants and Investigators † 1 Department of Health Sciences, Public University of Navarre, Arrosadia Campus, 31006 Pamplona, Spain 2 Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea Street 3, 31008 Pamplona, Spain 3 Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany 4 Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284-2018, USA * Author to whom correspondence should be addressed. † The full list of the CENTER-TBI participants and investigators can be found in the Supplementary Materials. J. Clin. Med. 2022, 11(14), 4090; https://doi.org/10.3390/jcm11144090 Received: 20 May 2022 / Revised: 10 July 2022 / Accepted: 13 July 2022 / Published: 14 July 2022 (This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes) Download Browse Figures Versions Notes Abstract Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months post-injury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI.

• Volovici, Victor; Pisică, Dana; Gravesteijn, Benjamin; Dirven, Clemens M. F.; Steyerberg, Ewout W. & Ercole, Ari [Show all 50 contributors for this article] (2022). Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. Acta Neurochirurgica. ISSN 0001-6268. 164, p. 1693–1705. doi: 10.1007/s00701-022-05257-z. Full text in Research Archive Show summary

  Objective To compare outcomes between patients with primary external ventricular device (EVD)–driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)–driven treatment. Methods The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with “center” as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. Results A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36–1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34–2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. Conclusion We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor–guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group.

• Løke, Daniel; Andelic, Nada; Helseth, Eirik; Vassend, Olav Mandt; Andersson, Stein & Ponsford, Jennie L. [Show all 9 contributors for this article] (2022). Impact of Somatic Vulnerability, Psychosocial Robustness and Injury-Related Factors on Fatigue following Traumatic Brain Injury—A Cross-Sectional Study. Journal of Clinical Medicine. 11(6), p. 1–19. doi: 10.3390/jcm11061733. Full text in Research Archive Show summary

  Fatigue is a common symptom after traumatic brain injuries (TBI) and a crucial target of rehabilitation. The subjective and multifactorial nature of fatigue necessitates a biopsychosocial approach in understanding the mechanisms involved in its development. The aim of this study is to provide a comprehensive exploration of factors relevant to identification and rehabilitation of fatigue following TBI. Ninety-six patients with TBI and confirmed intracranial injuries were assessed on average 200 days post-injury with regard to injury-related factors, several patient-reported outcome measures (PROMS) of fatigue, neuropsychological measures, and PROMS of implicated biopsychosocial mechanisms. Factor analytic approaches yielded three underlying factors, termed Psychosocial Robustness, Somatic Vulnerability and Injury Severity. All three dimensions were significantly associated with fatigue in multiple regression analyses and explained 44.2% of variance in fatigue. Post hoc analyses examined univariate contributions of the associations between the factors and fatigue to illuminate the relative contributions of each biopsychosocial variable. Implications for clinical practice and future research are discussed.

• Andersson, Helene; Jablonski, Greg Eigner; Nordahl, Stein Helge Glad; Nordfalk, Karl; Helseth, Eirik & Martens, Camilla [Show all 8 contributors for this article] (2021). The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma. The Laryngoscope. ISSN 0023-852X. 132(2), p. 443–448. doi: 10.1002/lary.29851. Full text in Research Archive Show summary

  Objectives: Head trauma may cause dislodgement of otoconia and development of benign paroxysmal positional vertigo (BPPV). The risk of developing BPPV is expected to be highest shortly after the trauma, then decrease and approach the risk seen in the general population. The aim of this study was to estimate the risk-time curve of BPPV development after head trauma. Study Design: Prospective observational study. Methods: Patients with minimal, mild, or moderate head trauma treated at the Department of Neurosurgery or the Department of Orthopedic Emergency at Oslo University Hospital, were interviewed and examined for BPPV using the Dix-Hallpike and supine roll maneuvers. BPPV was diagnosed according to the International diagnostic criteria of the Bárány Society. Telephone interviews were conducted at 2, 6, and 12 weeks after the first examination. Results: Out of 117 patients, 21% developed traumatic BPPV within 3 months after the trauma. The corresponding numbers were 12% with minimal trauma, 24% with mild, and 40% with moderate trauma. The difference in prevalence between the groups was significant (P = .018). During the first 4 weeks after the trauma, it was observed 20, 3, 0, and 1 BPPV onsets, respectively. No BPPV cases were seen for the remainder of the 3-month follow-up. Conclusion: The risk of developing BPPV after minimal-to-moderate head trauma is considerable and related to trauma severity. Most cases occur within few days after the trauma, but any BPPV occurring within the first 2 weeks after head trauma are likely due to the traumatic event.

• Andelic, Nada; Røe, Cecilie; Tenovuo, Olli; Azouvi, Philippe; Dawes, Helen & Majdan, Marek [Show all 56 contributors for this article] (2021). Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study. Journal of Clinical Medicine. 10(5). doi: 10.3390/jcm10051035. Full text in Research Archive Show summary

  This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the CENTER-TBI study with severe-to-moderate disability. Impairments in five outcome domains (daily life activities, physical, cognition, speech/language, and psychological) and the use of respective rehabilitation services (occupational therapy, physiotherapy, cognitive and speech therapies, and psychological counselling) were recorded. Sociodemographic and injury-related factors were used to investigate the probability of receiving rehabilitation. Physiotherapy was the most frequently provided rehabilitation service, followed by speech and occupational therapy. Psychological counselling was the least frequently accessed service. The probability of receiving a rehabilitative intervention increased for individuals with greater brain injury severity (odds ratio (OR) 1.75, CI 95%: 1.27–2.42), physical (OR 1.92, CI 95%: 1.21–3.05) and cognitive problems (OR 4.00, CI 95%: 2.34–6.83) but decreased for individuals reporting psychological problems (OR 0.57, CI 95%: 1.21–3.05). The study results emphasize the need for more extensive prescription of rehabilitation services for individuals with disability. Moreover, targeted rehabilitation programs, which aim to improve outcomes, should specifically involve psychological services to meet the needs of individuals recovering from TBI.

• Weber, Clemens; Myrseth, Erling; Kurz, Kathinka Dæhli; Frič, Radek; Ingebrigtsen, Tor & Helseth, Eirik [Show all 8 contributors for this article] (2021). MR av nakke i vektbærende stilling? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(11), p. 1–3. doi: 10.4045/tidsskr.21.0284. Full text in Research Archive

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• Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Sorteberg, Angelika; Padayachy, Llewellyn & Helseth, Eirik [Show all 7 contributors for this article] (2025). In Reply: Comment on “Real-Time Automated Measurements of Optic Nerve Sheath Diameter for Noninvasive Assessment of Intracranial Pressure in Aneurysmal Subarachnoid Hemorrhage”. Neurocritical Care. ISSN 1541-6933. doi: 10.1007/s12028-025-02279-0. Full text in Research Archive
• Netteland, Dag Ferner; Næss, Pål Aksel; Gaarder, Aslaug Christine & Helseth, Eirik (2024). Letter to the editor. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 32(1). doi: 10.1186/s13049-024-01199-w. Full text in Research Archive
• Rasmussen, Mari Storli; Andelic, Nada; Selj, Joanna Nordhagen; Danielsen, Vilde Marie; Løvstad, Marianne & Howe, Emilie Isager [Show all 30 contributors for this article] (2024). Self-management support program delivered in the sub-acute phase after traumatic injury-study protocol for a pragmatic randomized controlled trial. Trials. 25(1), p. 639–639. doi: 10.1186/s13063-024-08492-0. Full text in Research Archive Show summary

  Background Traumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury. Methods This study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure. Discussion This RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers. Trial registration The study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

• Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Padayachy, Llewellyn; Helseth, Eirik & Brekken, Reidar (2024). In Reply: Noninvasive Assessment of Intracranial Pressure: Deformability Index as an Adjunct to Optic Nerve Sheath Diameter to Increase Diagnostic Ability. Neurocritical Care. ISSN 1541-6933. 41, p. 307–309. doi: 10.1007/s12028-024-02027-w. Full text in Research Archive
• Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Padayachy, Llewellyn; Helseth, Eirik & Brekken, Reidar (2024). In Reply: Possible Factors Missed While Assessing Optic Nerve Sheath Diameter and Deformability Index in Patients with Severe Traumatic Brain Injury. Neurocritical Care. ISSN 1541-6933. 41, p. 305–306. doi: 10.1007/s12028-024-02015-0. Full text in Research Archive
• Søberg, Helene L.; Moksnes, Håkon Øgreid; Anke, Audny Gabriele Wagner; Røise, Olav; Røe, Cecilie & Aas, Eline [Show all 20 contributors for this article] (2022). Erratum: Rehabilitation Needs, Service Provision, and Costs in the First Year following Traumatic Injuries: Protocol for a Prospective Cohort Study ((JMIR Res Protoc (2021) 10: 4 (e25980) DOI: 10.2196/25980). JMIR Research Protocols. 11(3). doi: 10.2196/37723. Full text in Research Archive
• Storvig, Gøril; Sødal, Hild Flatmark; Robinson, Hilde Stendal; Tverdal, Cathrine Buaas; Helseth, Eirik & Taubøll, Erik (2022). Tidlig post-traumatiske epileptiske anfall hos pasienter med traumatisk hjerneskade. Full text in Research Archive

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