ArticleJournal of clinical medicine2023
Neuroworsening in the Emergency Department Is a Predictor of Traumatic Brain Injury Intervention and Outcome: A TRACK-TBI Pilot Study.
Article in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Action Collaborative on Traumatic Brain Injury Care: Adapted Clinical Practice Guideline.Annals of family medicine · 2025Guideline
- Intracerebral Glutamate and Glycerol in Severe Acute Brain Injury: Retrospective Study of Association With Neuroworsening and Outcome.Acta anaesthesiologica Scandinavica · 2026Observational
- Long-term functional outcomes following pediatric decompressive craniectomy for traumatic brain injury.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- Neuroworsening in traumatic brain injury: A consensus of the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC) expert group.Neurosurgical review · 2026Article
- Article
- Acute Surgery vs Conservative Treatment for Traumatic Acute Subdural Hematoma.JAMA network open · 2025Observational
- Clinical Assessment on Days 1-14 for the Characterization of Traumatic Brain Injury: Recommendations from the 2024 NINDS Traumatic Brain Injury Classification and Nomenclature Initiative Clinical/Symptoms Working Group.Journal of neurotrauma · 2025Review
- Noninvasive Monitoring of Traumatic Intracranial Hematoma Progression Using the Infrascanner: Preliminary Experience.Journal of the American College of Emergency Physicians open · 2025Article
- Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States: report from the 18-centre TRACK-TBI cohort study.Lancet regional health. Americas · 2024Article
- Isolated Traumatic Subarachnoid Hemorrhage on Head Computed Tomography Scan May Not Be Isolated: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (TRACK-TBI) Study.Journal of neurotrauma · 2024Article
- Mortality Predictors for Adult Patients with Mild-to-Moderate Traumatic Brain Injury: A Literature Review.Neurology international · 2024Review
- Traumatic Brain Injury: Contemporary Challenges and the Path to Progress.Journal of clinical medicine · 2023Article
- Inpatient Metabolic Panel Trajectories Improve 6-Month Mortality Prognostication after Severe Traumatic Brain Injury.Neurotrauma reportsArticle
- Ultra-early neurological pupil index trajectories and clinical outcomes in acute brain injury.Frontiers in neurologyArticle
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Authors and funding
21 authors at 6 institutions in 1 country.
Funding
Abstract
introductionNeuroworsening may be a sign of progressive brain injury and is a factor for treatment of traumatic brain injury (TBI) in intensive care settings. The implications of neuroworsening for clinical management and long-term sequelae of TBI in the emergency department (ED) require characterization.
methodsAdult TBI subjects from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot Study with ED admission and disposition Glasgow Coma Scale (GCS) scores were extracted. All patients received head computed tomography (CT) scan <24 h post-injury. Neuroworsening was defined as a decline in motor GCS at ED disposition (vs. ED admission). Clinical and CT characteristics, neurosurgical intervention, in-hospital mortality, and 3- and 6-month Glasgow Outcome Scale-Extended (GOS-E) scores were compared by neuroworsening status. Multivariable regressions were performed for neurosurgical intervention and unfavorable outcome (GOS-E ≤ 3). Multivariable odds ratios (mOR) with [95% confidence intervals] were reported.
resultsIn 481 subjects, 91.1% had ED admission GCS 13-15 and 3.3% had neuroworsening. All neuroworsening subjects were admitted to intensive care unit (vs. non-neuroworsening: 26.2%) and were CT-positive for structural injury (vs. 45.4%). Neuroworsening was associated with subdural (75.0%/22.2%), subarachnoid (81.3%/31.2%), and intraventricular hemorrhage (18.8%/2.2%), contusion (68.8%/20.4%), midline shift (50.0%/2.6%), cisternal compression (56.3%/5.6%), and cerebral edema (68.8%/12.3%; all
conclusionsNeuroworsening in the ED is an early indicator of TBI severity, and a predictor of neurosurgical intervention and unfavorable outcome. Clinicians must be vigilant in detecting neuroworsening, as affected patients are at increased risk for poor outcomes and may benefit from immediate therapeutic interventions.
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