Odette Harris, MD, MPH

All Publications

• Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury. Neurotrauma reports Hawryluk, G. W., Selph, S., Lumba-Brown, A., Totten, A. M., Ghajar, J., Aarabi, B., Ecklund, J., Shackelford, S., Adams, B., Adelson, D., Armonda, R. A., Benjamin, J., Boone, D., Brody, D., Dengler, B., Figaji, A., Grant, G., Harris, O., Hoffer, A., Kitigawa, R., Latham, K., Neal, C., Okonkwo, D. O., Pannell, D., Rosenfeld, J. V., Rosenthal, G., Rubiano, A., Stein, D. M., Stippler, M., Talbot, M., Valadka, A., Wright, D. W., Davis, S., Bell, R. 2022; 3 (1): 240-247

  Abstract

  Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and healthcare costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. A preliminary literature search revealed a need for updated guidelines, supported by the Brain Trauma Foundation. Methodologists experienced in TBI guidelines were recruited to support project development alongside two cochairs and a diverse steering committee. An expert multi-disciplinary workgroup was established and vetted to inform key clinical questions, to perform an evidence review and the development of recommendations relevant to pTBI. The methodological approach for the project was finalized. The development of up-to-date evidence- and consensus-based clinical care guidelines and algorithms for pTBI will provide critical guidance to care providers in the pre-hospital and emergent, medical, and surgical settings.

  View details for DOI 10.1089/neur.2022.0008

  View details for PubMedID 35919507

  View details for PubMedCentralID PMC9279118

• Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury NEUROTRAUMA REPORTS Hawryluk, G. J., Selph, S., Lumba-Brown, A., Totten, A. M., Ghajar, J., Aarabi, B., Ecklund, J., Shackelford, S., Adams, B., Adelson, D., Armonda, R. A., Benjamin, J., Boone, D., Brody, D., Dengler, B., Figaji, A., Grant, G., Harris, O., Hoffer, A., Kitigawa, R., Latham, K., Neal, C., Okonkwo, D. O., Pannell, D., Rosenfeld, J., Rosenthal, G., Rubiano, A., Stein, D. M., Stippler, M., Talbot, M., Valadka, A., Wright, D. W., Davis, S., Bell, R. 2022; 3 (1): 240-247

  View details for DOI 10.1089/neur.2022.0008

  View details for Web of Science ID 000813892800001

• Sex differences in cortical thickness and diffusion properties in patients with traumatic brain injury: a pilot study. Brain injury Adamson, M. M., Main, K., Harris, O. A., Kang, X. 1800: 1-15

  Abstract

  OBJECTIVE: Cortical thickness and diffusion properties are important measures of gray and white matter integrity in those with traumatic brain injury (TBI). Many studies show that healthy adult females have greater cortical thickness than males across numerous brain sites. In this study, we explored this sex difference in patients with TBI.METHOD: Participants consisted of 32 patients with TBI and 21 neurologically healthy controls. All were scanned by magnetic resonance imaging (MRI). Differences in cortical thickness and diffusion properties were examined between groups (i.e., TBI/control, male/female).RESULTS: Patients with TBI had more cortical thinning (both hemispheres) compared to controls. They also showed decreased fractional anisotropy (FA) for several major white matter tracts. Healthy females had significantly greater cortical thickness compared to healthy males. However, this difference was smaller among the patients with TBI. We found no sex differences in diffusion properties. There were moderate correlations between cortical thickness, diffusion properties, and cognitive performance, as measured by the Trail Making Test B.CONCLUSION: These findings contribute to a growing discussion on sex differences in cortical thickness and diffusion properties. Sexual dimorphism could necessitate different clinical profiles, targets, and rehabilitation strategies in patients with TBI.

  View details for DOI 10.1080/02699052.2022.2034046

  View details for PubMedID 35113752

• Developing a National Trauma Research Action Plan (NTRAP): Results from the Neurotrauma Research Panel Delphi Survey. The journal of trauma and acute care surgery Stein, D. M., Braverman, M. A., Phuong, J., Shipper, E., Price, M. A., Bixby, P. J., Adelson, P. D., Ansel, B. M., Cifu, D. X., DeVine, J. G., Galvagno, S. M., Gelb, D. E., Harris, O., Kang, C. S., Kitagawa, R. S., McQuillan, K. A., Patel, M. B., Robertson, C. S., Salim, A., Shutter, L., Valadka, A. B., Bulger, E. M., Adelson, P. D., Ansel, B. M., Chesnut, R. M., Cifu, D. X., DeVine, J. G., Galvagno, S. M., Gelb, D. E., Giacino, J. T., Harris, O., Hawryluk, G., Kang, C. S., Kitagawa, R. S., Manley, G. T., McQuillan, K. A., Merck, L. H., Okonkwo, D. O., Patel, M. B., Robertson, C. S., Salim, A., Shackelford, C. S., Sheth, K. N., Shutter, L., Stein, D. M., Valadka, A. B., Wade, C. E., Whyte, J., And the NTRAP Neurotrauma Panel Group 1800

  Abstract

  BACKGROUND: In 2016, the National Academies of Science, Engineering and Medicine (NASEM) called for the development of a National Trauma Research Action Plan (NTRAP). The Department of Defense funded the Coalition for National Trauma Research (CNTR) to generate a comprehensive research agenda spanning the continuum of trauma and burn care. Given the public health burden of injuries to the central nervous system, Neurotrauma was one of 11 panels formed to address this recommendation with a gap analysis and generation of high-priority research questions.METHODS: We recruited interdisciplinary experts to identify gaps in the neurotrauma literature, generate research questions, and prioritize those questions using a consensus-driven Delphi survey approach. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the importance of the questions on a 9-point Likert scale. Consensus was defined as ≥60% of panelists agreeing on the priority category. We then coded research questions using an NTRAP taxonomy of 118 research concepts, which were consistent across all 11 panels.RESULTS: Twenty-eight neurotrauma experts generated 675 research questions. Of these, 364 (53.9%) reached consensus, and 56 were determined to be high priority (15.4%), 303 were deemed to be medium priority (83.2%), and 5 were low priority (1.4%). The research topics were stratified into three groups - severe traumatic brain injury (TBI), mild TBI (mTBI), and spinal cord injury (SCI). The number of high-priority questions for each subtopic was 46 for severe TBI (19.7%), 3 for mTBI (4.3%) and 7 for SCI (11.7%).CONCLUSIONS: This Delphi gap analysis of neurotrauma research identified 56 high-priority research questions. There are clear areas of focus for severe TBI, mild TBI and SCI that will help guide investigators in future neurotrauma research. Funding agencies should consider these gaps when they prioritize future research.LEVEL OF EVIDENCE: IV.TYPE OF STUDY: Delphi panel gap analyses.

  View details for DOI 10.1097/TA.0000000000003527

  View details for PubMedID 35001020

• Headache Diary Mobile Application for Monitoring and Characterizing Posttraumatic Headaches. The Journal of head trauma rehabilitation Liu, K., Madrigal, E., Chung, J. S., Broffman, J. I., Bennett, N., Tsai, A., Adamson, M. M., Harris, O. A., Timmerman, M. 2022

  Abstract

  This study analyzed the data collected using a headache diary mobile application to characterize posttraumatic headaches (PTHs) in a sample of US veterans. Specifically, we measured patient engagement with the mobile application and compared our findings with previous literature regarding PTHs.A Headache Center of Excellence (HCoE) in a Veterans Health Administration facility.Forty-nine veterans currently being treated for ongoing PTH-related complaints with English fluency, reliable access to the internet, and a mobile phone.Observational study of PTH characteristics using the mobile application over the course of 1 year.Main outcome measures were collected via a headache diary mobile application developed for patients to track headache-associated symptoms, headache location, triggers, type, intensity, and duration. Patients also completed a baseline Headache Impact Test (HIT-6) survey.In total, 1569 entries were completed during the first year of application deployment. On average, patients completed 2.5 entries per week and used the application for 70 days. They frequently reported associated PTH symptoms of photophobia (56.7%) and headaches triggered by emotional stress (35.1%). Network analyses revealed patterns of co-occurrence in triggers of headache pain, associated symptoms, and headache pain location. Headache pain severity and impact ratings from the headache diary demonstrated convergent validity with the established HIT-6 measure.Headache diary mobile applications are a promising tool for monitoring and characterizing PTHs in veterans. Present results mirror past studies of PTH characteristics. Mobile application headache diaries may be used in both clinical and research settings to monitor headache symptoms and communicate the functional impact of headaches in real time.

  View details for DOI 10.1097/HTR.0000000000000771

  View details for PubMedID 35293366

• Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight. Neurosurgery Zuckerman, S. L., Yengo-Kahn, A. M., Tang, A. R., Bailes, J. E., Beauchamp, K., Berger, M. S., Bonfield, C. M., Camarata, P. J., Cantu, R. C., Davis, G. A., Ellenbogen, R. G., Ellis, M. J., Feuer, H., Guazzo, E., Harris, O. A., Heppner, P., Honeybul, S., Manley, G., Maroon, J. C., Miele, V. J., Nahed, B. V., Okonkwo, D. O., Oppenlander, M. E., Petty, J., Sabin, H. I., Samadani, U., Sherburn, E. W., Sheridan, M., Tator, C. H., Theodore, N., Timmons, S. D., Woodworth, G. F., Solomon, G. S., Sills, A. K. 2021

  Abstract

  BACKGROUND: Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI.OBJECTIVE: To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions.METHODS: A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted.RESULTS: Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size>10mm(52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (beta = -0.58, 95% CI -0.111, -0.005, P=.033).CONCLUSION: RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.

  View details for DOI 10.1093/neuros/nyab041

  View details for PubMedID 33693899

• Sex differences in symptom presentation and functional outcomes: a pilot study in a matched sample of veterans with mild TBI. Brain injury Gray, M., Adamson, M. M., Thompson, R. C., Kapphahn, K. I., Han, S., Chung, J. S., Harris, O. A. 2020: 1–13

  Abstract

  Primary Objective: Research focused on mild traumatic brain injury in active military and veteran populations details the psychological, neurological and functional outcomes of mTBI, in a primarily male (~95%) cohort. This may misrepresent female symptoms and outcomes. Here we assess for genuine sex differences in symptom presentation and functional outcomes.Research Design: We used matched pairs to preclude potential sex bias in outcome data.Methods and Procedures: We matched 49 female/male pairs on; 1) mechanism of injury, 2) time from injury to assessment and 3) age at assessment. Statistics were t-tests, chi-square, correlations and post hoc linear regression.Main outcomes and results: Outcome assessment revealed four significant (p <.05) sex differences; Living situation, Marital status, Vocation and Branch of service. Only the Neurobehavioral Symptom Inventory (NSI) composite cognitive domain factor was significantly different between females (mean: 10.26) and males (mean: 7.58). Linear regression confirmed a significant effect of sex for the cognitive composite (p =.002).Conclusion: We conclude that sex has a moderate effect on mTBI post-concussive symptom presentation. The significant sex difference in the NSI cognitive domain characterizes sex-related symptomology profiles providers can focus on for better rehabilitation management. Replication in the larger cohort would improve generalizability.Abbreviation: TBI: Traumatic Brain Injuries; mTBI: mild Traumatic Brain Injuries; OIF: Operation Iraqi Freedom; OEF: Operation Enduring Freedom; VA: Veterans Affairs Health Care System; PSC: Polytrauma System of Care; PRC: Polytrauma Rehabilitation Center; PTRP: Polytrauma Transitional Rehabilitation Program; PNS: Polytrauma Network Site; PTSD: Post Traumatic Stress Disorder; DoD: Department of Defense; NSI: Neurobehavioral Symptom Inventory; LOC: loss of consciousness; AOC: alteration of consciousness; PTA: posttraumatic amnesia; CPRS: computerized patient record system; CTBIE: Comprehensive TBI Evaluation; OCD: obsessive compulsive disorder; ETOH: alcohol abuse.

  View details for DOI 10.1080/02699052.2020.1725979

  View details for PubMedID 32064965

• A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive care medicine Chesnut, R., Aguilera, S., Buki, A., Bulger, E., Citerio, G., Cooper, D. J., Arrastia, R. D., Diringer, M., Figaji, A., Gao, G., Geocadin, R., Ghajar, J., Harris, O., Hoffer, A., Hutchinson, P., Joseph, M., Kitagawa, R., Manley, G., Mayer, S., Menon, D. K., Meyfroidt, G., Michael, D. B., Oddo, M., Okonkwo, D., Patel, M., Robertson, C., Rosenfeld, J. V., Rubiano, A. M., Sahuquillo, J., Servadei, F., Shutter, L., Stein, D., Stocchetti, N., Taccone, F. S., Timmons, S., Tsai, E., Ullman, J. S., Vespa, P., Videtta, W., Wright, D. W., Zammit, C., Hawryluk, G. W. 2020

  Abstract

  BACKGROUND: Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place.METHODS: Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting.RESULTS: We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms.CONCLUSIONS: These protocols are intended to assist clinicians in the management of patients with both ICP and brain oxygen monitors but they do not reflect either a standard-of-care or a substitute for thoughtful individualized management. These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference.

  View details for DOI 10.1007/s00134-019-05900-x

  View details for PubMedID 31965267

• International Prevalence and Correlates of Psychological Stress during the Global COVID-19 Pandemic. International journal of environmental research and public health Adamson, M. M., Phillips, A. n., Seenivasan, S. n., Martinez, J. n., Grewal, H. n., Kang, X. n., Coetzee, J. n., Luttenbacher, I. n., Jester, A. n., Harris, O. A., Spiegel, D. n. 2020; 17 (24)

  Abstract

  This study reports perceived stress and associated sociodemographic factors from an international sample of adults, during the COVID-19 pandemic. The Perceived Stress Scale (PSS-10) along with socio-demographic questions were conducted between 8 April 2020 and 11 May 2020. The survey was translated from English into five languages. Recruitment was conducted worldwide using social media. A total of 1685 survey responses were collected across 57 countries with eleven countries (≥30 responses/country) included in the sub-analyses. Overall, the mean PSS-10 score was 19.08 (SD = 7.17), reflecting moderate stress compared to previously reported norms. Female gender was associated with a higher PSS score (3.03, p < 0.05) as well as four-year degree holders (3.29, p < 0.05), while adults over 75 years (-7.46, p < 0.05) had lower PSS scores. Personal care composite score (including hours of sleep, exercise, and meditation) was associated with lower PSS scores (-0.39, p < 0.01). Increases in personal care and changes in work expectations were associated with lower PSS scores (-1.30 (p < 0.05) and -0.38 (p < 0.01), respectively). Lower total PSS scores were reported in Germany (-4.82, p < 0.01) compared to the global response sample mean. This information, collected during the initial period of global mitigation orders, provides insight into potential mental health risks and protective factors during crises.

  View details for DOI 10.3390/ijerph17249248

  View details for PubMedID 33321950

• Early Head Computed Tomography Abnormalities Associated with Elevated Intracranial Pressure in Severe Traumatic Brain Injury. Journal of neuroimaging : official journal of the American Society of Neuroimaging Murray, N. M., Wolman, D. N., Mlynash, M. n., Threlkeld, Z. D., Christensen, S. n., Heit, J. J., Harris, O. A., Hirsch, K. G. 2020

  Abstract

  Intracranial pressure (ICP) monitoring is recommended in severe traumatic brain injury (sTBI), yet invasive monitoring has risks, and many patients do not develop elevated ICP. Tools to identify patients at risk for ICP elevation are limited. We aimed to identify early radiologic biomarkers of ICP elevation.In this retrospective study, we analyzed a prospectively enrolled cohort of patients with a sTBI at an academic level 1 trauma center. Inclusion criteria were nonpenetrating TBI, age ≥16 years, Glasgow Coma Scale (GCS) score ≤8, and presence of an ICP monitor. Two independent reviewers manually evaluated 30 prespecified features on serial head computed tomography (CTs). Patient characteristics and radiologic features were correlated with elevated ICP. The primary outcome was clinically relevant ICP elevation, defined as ICP ≥ 20 mm Hg on at least 5 or more hourly recordings during postinjury days 0-7 with concurrent administration of an ICP-lowering treatment.Among 111 sTBI patients, the median GCS was 6 (interquartile range 3-8), and 45% had elevated ICP. Features associated with elevated ICP were younger age (every 10-year decrease, odds ratio [OR] 1.4), modified Fisher scale (mFS) score at 0-4 hours postinjury (every 1 point, OR 1.8), and combined volume of contusional hemorrhage and peri-hematoma edema (10 ml, OR 1.2) at 4-18 hours postinjury.Younger age, mFS score, and volume of contusion are associated with ICP elevation in patients with a sTBI. Imaging features may stratify patients by their risk of subsequent ICP elevation.

  View details for DOI 10.1111/jon.12799

  View details for PubMedID 33146933

• Introduction. Cranial surgery in geriatric patients. Neurosurgical focus Hamilton, M. G., Parney, I. n., Harris, O. A., Schmidt, E. A., Riina, H. A. 2020; 49 (4): E1

  View details for DOI 10.3171/2020.7.FOCUS20655

  View details for PubMedID 33002876

• Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. Neurosurgery Hawryluk, G. W., Rubiano, A. M., Totten, A. M., O'Reilly, C. n., Ullman, J. S., Bratton, S. L., Chesnut, R. n., Harris, O. A., Kissoon, N. n., Shutter, L. n., Tasker, R. C., Vavilala, M. S., Wilberger, J. n., Wright, D. W., Lumba-Brown, A. n., Ghajar, J. n. 2020

  Abstract

  When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of "living guidelines," whereby topics are updated more frequently, and between new editions, when important new evidence is published. The update to the decompressive craniectomy chapter presented here integrates the findings of the RESCUEicp study as well as the recently published 12-mo outcome data from the DECRA (Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury) trial. Incorporation of these publications into the body of evidence led to the generation of 3 new level-IIA recommendations; a fourth previously presented level-IIA recommendation remains valid and has been restated. To increase the utility of the recommendations, we added a new section entitled Incorporating the Evidence into Practice. This summary of expert opinion provides important context and addresses key issues for practitioners, which are intended to help the clinician utilize the available evidence and these recommendations. The full guideline can be found at: https://braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/.

  View details for DOI 10.1093/neuros/nyaa278

  View details for PubMedID 32761068

• A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive care medicine Hawryluk, G. W., Aguilera, S., Buki, A., Bulger, E., Citerio, G., Cooper, D. J., Arrastia, R. D., Diringer, M., Figaji, A., Gao, G., Geocadin, R., Ghajar, J., Harris, O., Hoffer, A., Hutchinson, P., Joseph, M., Kitagawa, R., Manley, G., Mayer, S., Menon, D. K., Meyfroidt, G., Michael, D. B., Oddo, M., Okonkwo, D., Patel, M., Robertson, C., Rosenfeld, J. V., Rubiano, A. M., Sahuquillo, J., Servadei, F., Shutter, L., Stein, D., Stocchetti, N., Taccone, F. S., Timmons, S., Tsai, E., Ullman, J. S., Vespa, P., Videtta, W., Wright, D. W., Zammit, C., Chesnut, R. M. 2019

  Abstract

  BACKGROUND: Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based.METHODS: We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists' decision tendencies were the focus of recommendations.RESULTS: We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination.CONCLUSIONS: Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.

  View details for DOI 10.1007/s00134-019-05805-9

  View details for PubMedID 31659383

• Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery NEUROSURGICAL FOCUS Kim, L. H., Quon, J. L., Sun, F. W., Wortman, K. M., Adamson, M. M., Harris, O. A. 2018; 45 (6): E16

  Abstract

  The impact of traumatic brain injury (TBI) has been demonstrated in various studies with respect to prevalence, morbidity, and mortality data. Many of the patients burdened with long-term sequelae of TBI are veterans. Although fewer in number, female veterans with TBI have been suggested to suffer from unique physical, mental, and social challenges. However, there remains a significant knowledge gap in the sex differences in TBI. Increased female representation in the military heralds an increased risk of TBI for female soldiers, and medical professionals must be prepared to address the unique health challenges in the face of changing demographics among the veteran TBI population. In this review, the authors aimed to present the current understanding of sex differences in TBI in the veteran population and suggest directions for future investigations.

  View details for PubMedID 30544324

• REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR IMPROVING COGNITION IN VETERANS WITH TBI: RESULTS FROM PILOT CLINICAL TRIAL Adamson, M., Siddiqi, S., Swaminath, G., Wu, L., Mcnerney, W., Darcy, V., Noda, A., Hernandez, B., Furst, A., Toll, R., Yutsis, M., Yochim, B., Clark, D., Etkin, A., Harris, O., Yesavage, J. MARY ANN LIEBERT, INC. 2018: A238

  View details for Web of Science ID 000441527400638

• Long-Term Functional Outcomes in Military Service Members and Veterans After Traumatic Brain Injury/Polytrauma Inpatient Rehabilitation ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Gray, M., Chung, J., Aguila, F., Williams, T., Teraoka, J. K., Harris, O. A. 2018; 99 (2): S33–S39

  Abstract

  To determine the effect of the established polytrauma/traumatic brain injury (TBI) infrastructure on immediate posttreatment functional gains, the long-term sustainability of any gains, and participation-related community reintegration outcomes in a baseline cohort of patients 8 years postadmission.Retrospective review and prospective repeated measures of an inception cohort.Polytrauma rehabilitation center (PRC).Patients consecutively admitted to the PRC inpatient rehabilitation unit during its first full fiscal year, 2006 (N=44).The PRC infrastructure and formalized rehabilitation for polytrauma/TBI.FIM scores at admission, discharge, 3 months, and 8 years postdischarge; participation-related socioeconomic factors reflecting community reintegration 8 years after admission.Functional gains were statistically significantly increased from admission to discharge. Improvements were maintained at both 3 months postdischarge and 8 years postdischarge. The socioeconomic data collected at 8-year follow-up showed >50% either competitively employed or continuing their education and 100% living in a noninstitutionalized setting.This study addresses a concern regarding the long-term functional outcomes of rehabilitation patients treated by the established infrastructure of the Polytrauma System of Care inpatient rehabilitation centers. The results suggest that polytrauma/TBI rehabilitation care using a comprehensive, integrated approach is effective and durable in achieving functional gains and successful community reintegration within our initial PRC cohort. Follow-up of subsequent fiscal year cohorts would add to the validity of these outcome findings.

  View details for PubMedID 28866009

• Prospective Tracking and Analysis of Traumatic Brain Injury in Veterans and Military Personnel ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Licona, N. E., Chung, J. S., Poole, J. H., Salerno, R. M., Laurenson, N. M., Harris, O. A. 2017; 98 (2): 391-394

  Abstract

  To describe the ongoing Clinical Tracking Form (CTF) study of the Defense and Veterans Brain Injury Center (DVBIC).Prospective longitudinal study. Data at baseline and postinjury are collected on participants through interview and questionnaire, review of medical records, and periodic follow-ups throughout their lifetime.A regional DVBIC site located at a Veterans Affairs Medical Center.Participants (N=211; age range, 18-75y) were enrolled between January 1, 2005, and December 31, 2012, at a regional DVBIC site.Not applicable.Injury information, functioning, and psychological health.Sixty percent of 211 participants were identified as having severe traumatic brain injuries (TBIs), 14% moderate TBIs, and 26% mild TBIs. Of these 211 participants, 79% sustained closed head injuries, 15% penetrating head injuries, and 6% were not reported. Comparing the severity of TBI in combat versus stateside situations, most of the mild injuries (71%) occurred in combat locations, while most of the severe injuries (62%) occurred in the United States. Among those injured in combat, blast-related TBIs (82%) greatly outnumbered non-blast-related TBIs, regardless of severity.The CTF study serves as a significant resource of data to understand the effect and outcomes of TBI in the military population. The lifelong experience of military veterans across the full spectrum of TBI and recovery will be recorded through the CTF, and will translate into more informed clinical decisions and educational efforts to guide future research pathways.

  View details for DOI 10.1016/j.apmr.2016.09.131

  View details for Web of Science ID 000393930100024

• Prospective Tracking and Analysis of Traumatic Brain Injury in Veterans and Military Personnel. Archives of physical medicine and rehabilitation Licona, N. E., Chung, J. S., Poole, J. H., Salerno, R. M., Laurenson, N. M., Harris, O. A. 2017; 98 (2): 391-394

  Abstract

  To describe the ongoing Clinical Tracking Form (CTF) study of the Defense and Veterans Brain Injury Center (DVBIC).Prospective longitudinal study. Data at baseline and postinjury are collected on participants through interview and questionnaire, review of medical records, and periodic follow-ups throughout their lifetime.A regional DVBIC site located at a Veterans Affairs Medical Center.Participants (N=211; age range, 18-75y) were enrolled between January 1, 2005, and December 31, 2012, at a regional DVBIC site.Not applicable.Injury information, functioning, and psychological health.Sixty percent of 211 participants were identified as having severe traumatic brain injuries (TBIs), 14% moderate TBIs, and 26% mild TBIs. Of these 211 participants, 79% sustained closed head injuries, 15% penetrating head injuries, and 6% were not reported. Comparing the severity of TBI in combat versus stateside situations, most of the mild injuries (71%) occurred in combat locations, while most of the severe injuries (62%) occurred in the United States. Among those injured in combat, blast-related TBIs (82%) greatly outnumbered non-blast-related TBIs, regardless of severity.The CTF study serves as a significant resource of data to understand the effect and outcomes of TBI in the military population. The lifelong experience of military veterans across the full spectrum of TBI and recovery will be recorded through the CTF, and will translate into more informed clinical decisions and educational efforts to guide future research pathways.

  View details for DOI 10.1016/j.apmr.2016.09.131

  View details for PubMedID 27794484

• Service needs and barriers to care five or more years after moderate to severe TBI among Veterans BRAIN INJURY Schulz-Heik, R., Poole, J. H., Dahdah, M. N., Sullivan, C., Adamson, M. M., Date, E. S., Salerno, R., Schwab, K., Harris, O. 2017; 31 (10): 1287–93

  Abstract

  The objective of this paper is to identify the most frequent service needs, factors associated with needs, and barriers to care among Veterans and service members five or more years after moderate to severe traumatic brain injury (TBI).Survey administered via telephone 5-16 years after injury (median eight years) and subsequent acute inpatient rehabilitation at a regional Veterans Affairs (VA) medical centre.Participants were 119 Veterans and military personnel, aged 23-70 (median 35), 90% male. Demographics, injury characteristics, service needs, whether needs were addressed, barriers to care, health and general functioning were assessed.The most frequent needs were for help with memory, information about available services and managing stress. Obtaining information about services was the most consistently un-addressed need; managing stress was the most consistently addressed need. Cognitive and psychiatric symptoms and alienation from community were associated with needs going un-addressed. Participants treated after an expansion of TBI services at the study site reported fewer un-addressed needs. Not knowing where to get help was the most common barrier to care.Repeated outreach, assessment of needs and education about available services are needed throughout Veterans' lifespan after moderate to severe TBI.

  View details for PubMedID 28585880

• Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery Carney, N., Totten, A. M., O'Reilly, C., Ullman, J. S., Hawryluk, G. W., Bell, M. J., Bratton, S. L., Chesnut, R., Harris, O. A., Kissoon, N., Rubiano, A. M., Shutter, L., Tasker, R. C., Vavilala, M. S., Wilberger, J., Wright, D. W., Ghajar, J. 2016: -?

  Abstract

  The scope and purpose of this work is 2-fold: to synthesize the available evidence and to translate it into recommendations. This document provides recommendations only when there is evidence to support them. As such, they do not constitute a complete protocol for clinical use. Our intention is that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insufficient. We think it is important to have evidence-based recommendations to clarify what aspects of practice currently can and cannot be supported by evidence, to encourage use of evidence-based treatments that exist, and to encourage creativity in treatment and research in areas where evidence does not exist. The communities of neurosurgery and neuro-intensive care have been early pioneers and supporters of evidence-based medicine and plan to continue in this endeavor. The complete guideline document, which summarizes and evaluates the literature for each topic, and supplemental appendices (A-I) are available online at https://www.braintrauma.org/coma/guidelines.TBI, traumatic brain injuryRESCUEicp, Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of ICP.

  View details for PubMedID 27654000

• Abducens Nerve Avulsion and Facial Nerve Palsy After Temporal Bone Fracture: A Rare Concomitance of Injuries. World neurosurgery Azad, T. D., Veeravagu, A., Corrales, C. E., Chow, K. K., Fischbein, N. J., Harris, O. A. 2016; 88: 689 e5-8

  Abstract

  Avulsion of the abducens nerve in the setting of geniculate ganglion injury after temporal bone fracture is unreported previously. We discuss clinical assessment and management of a patient with traumatic avulsion of cranial nerve (CN) VI in the setting of an ipsilateral CN VII injury after temporal bone fracture and call attention to this unusual injury.A 26-year-old man suffered a temporal bone fracture after a motor vehicle accident and developed diplopia and right-sided facial droop. Six weeks after the accident, the patient was readmitted with worsening diplopia and ipsilateral facial weakness. He demonstrated absent lateral gaze on the right suggestive of either restrictive movement or right.In addition, he had right-sided facial palsy graded as 6/6 House-Brackmann. High-resolution computed tomography demonstrated a right-sided longitudinal otic capsule-sparing temporal bone fracture that propagated into the facial nerve canal and geniculate fossa. Magnetic resonance imaging revealed discontinuity of the right CN VI between the pons and the Dorello canal, as well as injury to the ipsilateral geniculate ganglion. CN VII was intact proximally, from the pons through the internal auditory canal. Consensus was reached to proceed with conservative management. At 13 months after injury, the patient reported 1/6 House-Brackmann with no improvement in CN VI function.This case illustrates 2 subtle findings on imaging with potential therapeutic implications, notably the role of surgical intervention for facial nerve palsy.

  View details for DOI 10.1016/j.wneu.2015.11.076

  View details for PubMedID 26723286

• Intracranial Dislocation of the Mandibular Condyle: A Case Report and Literature Review WORLD NEUROSURGERY Zhang, M., Alexander, A. L., Most, S. P., Li, G., Harris, O. A. 2016; 86

  View details for DOI 10.1016/j.wneu.2015.09.007

  View details for PubMedID 26365884

• Interdisciplinary Rehabilitation Approach for Functional Neurological Symptom (Conversion) Disorder: A Case Study REHABILITATION PSYCHOLOGY Yam, A., Rickards, T., Pawlowski, C. A., Harris, O., Karandikar, N., Yutsis, M. V. 2016; 61 (1): 102-111

  Abstract

  To describe a coordinated interdisciplinary approach to the treatment of functional neurological symptom (conversion) disorder (FNSD), mixed symptoms, including motor dysfunction, in a rehabilitation setting.Adult patient was admitted with worsening neurological symptoms in the absence of contributory clinical pathology. Interdisciplinary diagnostic and treatment approach included physiatry, neuro- and rehabilitation- psychology, occupational, physical, recreational, and speech therapy. Providers coordinated care and delivered psychologically informed therapies consistent with the standards appropriate to the setting.Diagnosis of FNSD was made 5 weeks after admission. The patient achieved symptom remission at 13 weeks after admission. He remained symptom free at 6 months postdischarge.Rehabilitation settings are uniquely suited to the treatment of FNSD. (PsycINFO Database Record

  View details for DOI 10.1037/rep0000063

  View details for Web of Science ID 000371302000011

  View details for PubMedID 26689100

• Prognostic Value of Quantitative Diffusion-Weighted MRI in Patients with Traumatic Brain Injury JOURNAL OF NEUROIMAGING Shakir, A., Aksoy, D., Mlynash, M., Harris, O. A., Albers, G. W., Hirsch, K. G. 2016; 26 (1): 103-108

  Abstract

  Data about the predictive value of quantitative diffusion-weighted MRI in traumatic brain injury (TBI) patients is lacking. This study aimed to determine if specific apparent diffusion coefficient (ADC) thresholds could be determined that correlate with outcome in moderate-severe TBI.This retrospective observational study investigated patients with moderate-severe TBI. MRIs obtained post-injury days 1-13 were analyzed. MRIs were obtained on a 1.5T scanner; 20-23 contiguous diffusion-weighted imaging (DWI) sections with a spin-echo echo planar imaging DWI 256×256 reconstructed matrix; field of view 24×24 cm; slice thickness/gap of 5/1.5 or 5/2.5 mm. The ADC value of each brain tissue voxel was determined. The percentage of voxels below different ADC thresholds was calculated and correlated with outcome. A good outcome was defined as discharge to home or a rehabilitation facility.Seventy-six patients were analyzed. Thirty-five patients (46%) had a good outcome. The timing of MRI scans did not differ between groups, but the mean age did (42±18 years vs. 56±19 years, p<.01, good vs. poor outcome). Patients with poor outcome had significantly higher percentage of brain volume with ADC < 400×10(-6) mm2 /second (.85±.67% vs. .60±.29%, poor vs. good outcome, p<.05). Using a ROC curve analysis and Youden's index, an ADC <400×10(-6) mm2 /second in ≥.49% of brain was 85% sensitive and 46% specific for poor outcome (p<.05).Quantitative MRI offers additional prognostic information in acute TBI. A whole brain tissue ADC threshold of <400×10(-6) mm2 /second in ≥.49% of brain may be a novel prognostic biomarker.

  View details for DOI 10.1111/jon.12286

  View details for Web of Science ID 000368012400014

• Prognostic Value of Quantitative Diffusion-Weighted MRI in Patients with Traumatic Brain Injury. Journal of neuroimaging Shakir, A., Aksoy, D., Mlynash, M., Harris, O. A., Albers, G. W., Hirsch, K. G. 2016; 26 (1): 103-108

  Abstract

  Data about the predictive value of quantitative diffusion-weighted MRI in traumatic brain injury (TBI) patients is lacking. This study aimed to determine if specific apparent diffusion coefficient (ADC) thresholds could be determined that correlate with outcome in moderate-severe TBI.This retrospective observational study investigated patients with moderate-severe TBI. MRIs obtained post-injury days 1-13 were analyzed. MRIs were obtained on a 1.5T scanner; 20-23 contiguous diffusion-weighted imaging (DWI) sections with a spin-echo echo planar imaging DWI 256×256 reconstructed matrix; field of view 24×24 cm; slice thickness/gap of 5/1.5 or 5/2.5 mm. The ADC value of each brain tissue voxel was determined. The percentage of voxels below different ADC thresholds was calculated and correlated with outcome. A good outcome was defined as discharge to home or a rehabilitation facility.Seventy-six patients were analyzed. Thirty-five patients (46%) had a good outcome. The timing of MRI scans did not differ between groups, but the mean age did (42±18 years vs. 56±19 years, p<.01, good vs. poor outcome). Patients with poor outcome had significantly higher percentage of brain volume with ADC < 400×10(-6) mm2 /second (.85±.67% vs. .60±.29%, poor vs. good outcome, p<.05). Using a ROC curve analysis and Youden's index, an ADC <400×10(-6) mm2 /second in ≥.49% of brain was 85% sensitive and 46% specific for poor outcome (p<.05).Quantitative MRI offers additional prognostic information in acute TBI. A whole brain tissue ADC threshold of <400×10(-6) mm2 /second in ≥.49% of brain may be a novel prognostic biomarker.

  View details for DOI 10.1111/jon.12286

  View details for PubMedID 26296810

• Validity Assessment of Referral Decisions at a VA Health Care System Polytrauma System of Care. Cureus Chung, J., Aguila, F., Harris, O. 2015; 7 (1): e240

  Abstract

  There has been intensive interest to ensure equitable and appropriate access to the specialized rehabilitative services of the VA Polytrauma System of Care (PSC) for patients sustaining polytrauma and traumatic brain injuries (TBI). A retrospective cohort study with prospective data acquisition was conducted to assess validity and objectivity of the acceptance decision algorithm to the VA Palo Alto Health Care System (VAPAHCS) PSC. Our hypotheses are (1) VAPAHCS PSC referral decisions were appropriate and without bias and (2) the identified needs of redirected referrals were addressed. This analysis included 1,025 referrals (906 patients); 813 patients (89.7%) were accepted, and 93 (10.3%) were redirected. Redirected cases were older, were more often active duty service members, and were not from the West Coast. There were more females redirected due to concomitant spinal cord injury. These are rationale differences. In redirected patients, the most commonly identified rehabilitation needs were psychological support, mobility/physical therapy, and communication/speech services; >75% of patients had these services offered elsewhere outside of the PSC resources. While balancing financial stewardship and meeting our mission to provide outstanding rehabilitative care to veterans and service members, we demonstrated that acceptance decisions were valid and without bias, and redirected patients received appropriate alternate resources.

  View details for DOI 10.7759/cureus.240

  View details for PubMedID 26180664

  View details for PubMedCentralID PMC4494525

• Prediction of neurosurgical intervention after mild traumatic brain injury using the national trauma data bank. World journal of emergency surgery Sweeney, T. E., Salles, A., Harris, O. A., Spain, D. A., Staudenmayer, K. L. 2015; 10: 23-?

  Abstract

  Patients with mild traumatic brain injury (TBI) as defined by an admission Glasgow Coma Score (GCS) of 14-15 often do not require neurosurgical interventions, but which patients will go on to require neurosurgical care has been difficult to predict. We hypothesized that injury patterns would be associated with need for eventual neurosurgical intervention in mild TBI.The National Trauma Databank (2007-2012) was queried for patients with blunt injury and a diagnosis of TBI with an emergency department GCS of 14-15. Patients were stratified by age and injury type. Multiple logistic regression for neurosurgical intervention was run with patient demographics, physiologic variables, and injury diagnoses as dependent variables.The study included 50,496 patients, with an overall 8.8 % rate of neurosurgical intervention. Neurosurgical intervention rates varied markedly according to injury type, and were only correlated with age for patients with epidural and subdural hemorrhage. In multiple logistic regression, TBI diagnoses were predictive of need for neurosurgical interventions; moreover, after controlling for injury type and severity score, age was not significantly associated with requiring neurosurgical intervention.We found that in mild TBI, injury pattern is associated with eventual need for neurosurgical intervention. Patients with cerebral contusion or subarachnoid hemorrhage are much less likely to require neurosurgical intervention, and the effects of age are not significant after controlling for other patient factors. Prospective studies should validate this finding so that treatment guidelines can be updated to better allocate ICU resources.

  View details for DOI 10.1186/s13017-015-0017-6

  View details for PubMedID 26060506

  View details for PubMedCentralID PMC4460849

• Prediction of neurosurgical intervention after mild traumatic brain injury using the national trauma data bank. World journal of emergency surgery Sweeney, T. E., Salles, A., Harris, O. A., Spain, D. A., Staudenmayer, K. L. 2015; 10: 23-?

  Abstract

  Patients with mild traumatic brain injury (TBI) as defined by an admission Glasgow Coma Score (GCS) of 14-15 often do not require neurosurgical interventions, but which patients will go on to require neurosurgical care has been difficult to predict. We hypothesized that injury patterns would be associated with need for eventual neurosurgical intervention in mild TBI.The National Trauma Databank (2007-2012) was queried for patients with blunt injury and a diagnosis of TBI with an emergency department GCS of 14-15. Patients were stratified by age and injury type. Multiple logistic regression for neurosurgical intervention was run with patient demographics, physiologic variables, and injury diagnoses as dependent variables.The study included 50,496 patients, with an overall 8.8 % rate of neurosurgical intervention. Neurosurgical intervention rates varied markedly according to injury type, and were only correlated with age for patients with epidural and subdural hemorrhage. In multiple logistic regression, TBI diagnoses were predictive of need for neurosurgical interventions; moreover, after controlling for injury type and severity score, age was not significantly associated with requiring neurosurgical intervention.We found that in mild TBI, injury pattern is associated with eventual need for neurosurgical intervention. Patients with cerebral contusion or subarachnoid hemorrhage are much less likely to require neurosurgical intervention, and the effects of age are not significant after controlling for other patient factors. Prospective studies should validate this finding so that treatment guidelines can be updated to better allocate ICU resources.

  View details for DOI 10.1186/s13017-015-0017-6

  View details for PubMedID 26060506

  View details for PubMedCentralID PMC4460849

• A Systematic Review of an Emerging Consciousness Population: Focus on Program Evolution JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE Gray, M., Lai, S., Wells, R., Chung, J., Teraoka, J., Howe, L., Harris, O. A. 2011; 71 (5): 1465-1474

  View details for DOI 10.1097/TA.0b013e31821f82f5

  View details for Web of Science ID 000297118600072

  View details for PubMedID 22071939

• Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States Clinical article JOURNAL OF NEUROSURGERY Kalanithi, P., Schubert, R. D., Lad, S. P., Harris, O. A., Boakye, M. 2011; 115 (5): 1013-1018

  Abstract

  This study provides the first US national data regarding frequency, cost, and mortality rate of traumatic subdural hematoma (SDH), and identifies demographic factors affecting morbidity and death in patients with traumatic SDH undergoing surgical drainage.A retrospective analysis was conducted by querying the Nationwide Inpatient Sample, the largest all-payer database of nonfederal community hospitals. All cases of traumatic SDH were identified using ICD-9 codes. The study consisted of 2 parts: 1) trends data, which were abstracted from the years 1993-2006, and 2) univariate analysis and multivariate logistic regression of demographic variables on inhospital complications and deaths for the years 1993-2002.Admissions for traumatic SDH increased 154% from 17,328 in 1993 to 43,996 in 2006. Inhospital deaths decreased from 16.4% to 11.6% for traumatic SDH. Average costs increased 67% to $47,315 per admission. For the multivariate regression analysis, between 1993 and 2002, 67,864 patients with traumatic SDH underwent operative treatment. The inhospital mortality rate was 14.9% for traumatic SDH drainage, with an 18% inhospital complication rate. Factors affecting inhospital deaths included presence of coma (OR = 2.45) and more than 2 comorbidities (OR = 1.60). Increased age did not worsen the inhospital mortality rate.Nationally, frequency and cost of traumatic SDH cases are increasing rapidly.

  View details for DOI 10.3171/2011.6.JNS101989

  View details for Web of Science ID 000296377800026

  View details for PubMedID 21819196

• The role of hypothermia in the management of severe brain injury. A meta-analysis ARCHIVES OF NEUROLOGY Harris, O. A., Colford, J. M., Good, M. C., Matz, P. G. 2002; 59 (7): 1077-1083

  Abstract

  Hypothermia is utilized in the management of severe traumatic brain injury despite the lack of unequivocal evidence supporting its use. Because of its widespread use, the effects of hypothermia are a concern.To determine the effectiveness of hypothermia in the management of severe brain injury.Two investigators working independently abstracted data in a blinded fashion from studies identified using multiple literature databases, including MEDLINE, Ovid, PubMed, the Cochrane Database of Systematic Reviews, EMBASE, and the abstract center for the American Association of Neurological Surgery and the Congress of Neurological Surgery, as well as the bibliographies of these articles. Additionally, experts in the field of hypothermia and neurotrauma provided additional references.Seven studies met predetermined inclusion criteria: (1) the study was a randomized clinical trial comparing the efficacy of hypothermia vs normothermia in patients with posttraumatic head injury, (2) only subjects aged 10 years or older were included in the study, and (3) relative risks (odds ratios [ORs], cumulative incidence, or incidence density measures) and 95% confidence intervals (CIs) or weighted mean differences and 95% CIs could be calculated from the data presented in the article. These criteria were applied in a blinded fashion by 2 independent investigators.No single outcome variable was evaluated in all studies. The following outcome variables were assessed: intracranial pressure, Glasgow Outcome Scale score, pneumonia, cardiac arrhythmia, prothrombin time, and partial thromboplastin time. Either ORs or weighted mean differences (when the data provided did not permit calculation of an OR) comparing the effects of hypothermia vs normothermia were calculated from the data provided.The weighted mean difference (hypothermia - normothermia) for intracranial pressure was -2.98 mm Hg (95% CI, -7.58 to 1.61; P =.2). The OR (hypothermia vs normothermia) for Glasgow Outcome Scale score was 0.61 (95% CI, 0.26-1.46; P =.3). The OR for pneumonia was 2.05 (95% CI, 0.79-5.32; P =.14). The OR for cardiac arrhythmia was 1.27 (95% CI, 0.38-4.25; P =.7). The weighted mean difference for prothrombin time was 0.02 seconds (95% CI, -0.07 to 0.10; P =.7). The weighted mean difference for partial thromboplastin time was 2.22 seconds (95% CI, 1.73-2.71; P<.001).This meta-analysis of randomized controlled trials suggests that hypothermia is not beneficial in the management of severe head injury. However, because hypothermia continues to be used to treat these injuries, additional studies are justified and urgently needed.

  View details for Web of Science ID 000176714500002

  View details for PubMedID 12117354

• Infratentorial traumatic brain hemorrhage: May outcome be predicted by initial GCS? 49th Annual Meeting of the Congress-of-Neurosurgeons Harris, O. A., Lane, B., Lewen, A., Matz, P. G. LIPPINCOTT WILLIAMS & WILKINS. 2000: 1076–82

  Abstract

  Overall prognosis of nonpenetrating traumatic brain hemorrhage may be predicted by neurologic function days after insult. The relationship between immediate function and outcome has not been examined for infratentorial traumatic brain hemmorhage (iTBH) identified on computed tomographic (CT) scan. Given the severity of brain stem injury, it is conceivable that immediate function may be predictive.A retrospective review of 1,500 brain injuries occurring at our institution identified 18 patients (1.2%) with iTBH on CT scan (eight brain stem, five cerebellum, five both). Demographics, supratentorial injuries, and outcome at 6 months (Glasgow Outcome Scale) were recorded.Initial Glasgow Coma Scale (GCS) in 11 patients was less than 5 (group I). Seven patients had GCS scores greater than or equal to 6 (group II). Nine patients in group I either died or were vegetative. In group II, one died; none were vegetative (p < 0.02). Regression analysis demonstrated a strong correlation between initial GCS and Glasgow Outcome Scale scores at 6 months for all patients (p < 0.001).We conclude that initial GCS score may be predictive of long-term outcome in patients with CT scan evidence of iTBH-a relationship to be explored further for prognostic information.

  View details for Web of Science ID 000165909500018

  View details for PubMedID 11130492

• Acquired cerebral arteriovenous malformation induced by an anaplastic astrocytoma: An interesting case NEUROLOGICAL RESEARCH Harris, O. A., Chang, S. D., Harris, B. T., Adler, J. R. 2000; 22 (5): 473-477

  Abstract

  High grade gliomas foster an environment rich in angiogenic factors that promote neovascularity. We report a case of a cerebral arteriovenous malformation, which developed in the setting of a high grade astrocytoma. The patient presented with complaints of confusion and left hemiparesis. An initial cerebral angiogram was normal. Repeat angiography six weeks later demonstrated an extremely vascular lesion with arteriovenous shunting involving the right thalamus and occipital lobe. Histopathologic evaluation of open biopsy and autopsy specimens demonstrated a high grade astrocytoma in association with an arteriovenous malformation. Immunohistochemical staining with VEGF was diffusely positive. A possible role for the hyperangiogenic environment of a high grade astrocytoma resulting in the development of an arteriovenous malformation is discussed.

  View details for Web of Science ID 000088406000007

  View details for PubMedID 10935219

• Analysis of the proliferative potential of residual tumor after radiosurgery for intraparenchymal brain metastases JOURNAL OF NEUROSURGERY Harris, O. A., Adler, J. R. 1996; 85 (4): 667-671

  Abstract

  A retrospective immunohistochemical study of radiosurgically treated brain metastases was performed to determine whether residual tumor has reduced proliferative potential. The monoclonal antibodies MIB-10 and PC-10 were used as markers for proliferation. The experimental group consisted of pathological specimens obtained from five patients in whom brain metastasis previously had been treated with radiosurgery. Pathological specimens obtained from 10 patients with brain metastases, matched in histology to diseases in the experimental group but untreated by radiosurgery, served as controls. A significant decrease in proliferative indices was observed in metastatic brain cancers after radiosurgery (p < 0.001). These results indicate that the persistent tumor that is present at the site of a metastasis previously treated with radiosurgery is less viable and may not in itself be a significant finding.

  View details for Web of Science ID A1996VJ24700021

  View details for PubMedID 8814172