Neurocritical Care and TBI: Beyond the ICU: Impacting Long-Term Outcomes Following Neurological Critical Illness and TBI*

Date: Monday, September 16, 2024
Time: 4:15 PM to 5:45 PM
Room: Lake Nona A
Track: Special Interest Group (SIG)
Level: ANA2024

Description

The session will focus on current clinical and translational research aimed at understanding long-term neurocognitive, psychological, and physical sequelae following neurological critical illness and traumatic injuries of the brain and spinal cord. The long-term impact of critical illness on both survivors and their caregivers has been increasingly recognized in general critical care populations. While initial studies excluded those with neurological insults as the cause of their critical illness, efforts to better understand the effects of neurological critical illness and traumatic injuries of the nervous system have recently begun. While there are many parallels to the general critical care population, there are also distinct considerations in survivors of neurological critical illness, particularly TBI. The impacts on both survivors and caregivers, including emotional distress, psychological impacts, and cognitive functioning, will be discussed. The unique challenges to recovery encountered in marginalized populations will also be explored. The goal of the session is to improve learners’ understanding of the long-term impacts of acute neurological injury to ultimately aid in addressing mechanisms of secondary insult and develop systems of care that lead to improved neurological outcomes and quality of life for survivors and their caregivers.

Objectives

  • Identify the risk of long-term neurocognitive, psychological, and physical effects of critical illness and traumatic brain injury.

  • Describe the long-term risks of critical neurological illness and traumatic brain injury.

  • Discuss the long-term sequelae of neurological critical illness/injury with patients and caregivers. 

Speakers

  • Beyond the ICU: Impacting Long-Term Outcomes Following Neurological Critical Illness and TBI

    Description

    The NeuroICU admission presents an extraordinary opportunity to relieve suffering, restore function to individuals who have suffered devastating injuries, as well as their families. Equally powerful is the opportunity to intervene to lengthen the healthspan of our patients and families. In this presentation we will focus on the specific interventions neurointensivists can make that will shape the lives of their patients and families for years and decades beyond discharge.

    Speakers
    (Speaker) Jonathan Rosand, MD, MSc, FANA

  • Can the Incorporation of Quantitative Markers and Death Improve the Prediction of Post-Ischemic Stroke Epilepsy?

    Description

    SeLECT is a validated post-ischemic stroke epilepsy (PISE) prognostic model. While its positive predictive value (PPV) doubles PISE incidence, the false-positive predictions at the first-year post-stroke remain high. Our goal was to improve PISE prediction. In this retrospective study (2014-2022), we included adult ischemic stroke patients at a single center with neuroimaging and electroencephalography (EEG) 7 days post-stroke. Outcomes included time from stroke to PISE, or death. In the training cohort (n=230), proportional cause-specific hazard models identified quantitative PISE biomarkers and death predictors. A predictive model using a random survival forest with competing risk was trained and used to evaluate a testing cohort (n=50). Of 280 patients included, 53 developed PISE. Quantitative biomarkers predictive of PISE included 72h NIHSS, infarct volume, epileptiform abnormality burden, asymmetry measures. We also identified death predictors. Our model benefit was most prominent in high SeLECT patients, suggesting it likely complements SeLECT via two-step risk stratification.

    Speakers
    (Speaker) Jennifer Kim, MD PhD

  • Long-Term Outcomes after TBI with Special Interest in Women and Marginalized Groups

    Description

    This presentation aims to disseminate research on the intersection of traumatic brain injury outcomes with a focus on underserved populations with an intersectional sex and gender lens. The presentation will draw upon a program of research supported by Canada Research Chair in Traumatic Brain Injury in Underserved Populations based at the University of Toronto which includes persons who experience homelessness, intimate partner violence and involvement in the criminal-legal system. Results from recently published systematic reviews on sex and gender effects of traumatic brain injury are included. The findings from three scoping reviews on rehabilitation for persons experiencing intimate partner violence, homelessness and involvement in the criminal legal system as well as an examination of equity considerations in clinical practice guidelines for traumatic brain injury and homelessness will also be presented. Dedicated time for sharing of resources, discussion and knowledge exchange is anticipated.

    Speakers
    (Speaker) Angela Colantonio, PhD, FCAHS, FACRM

  • Relationship between Social Determinants of Health (SDOH), Clinical Phenotypes, and Disability in Subacute-Long Term TBI

    Description

    Traumatic brain injury (TBI) is a chronic disease with an incidence of 64-74 million cases annually and diverse clinical symptoms that are disabling. The individual differences in post-TBI recovery as related to clinical phenotypes (main symptom), and if clinical phenotypes are related to SDOH, remain underexplored. In our predominantly mild-TBI clinic cohort, we found clinical differences that distinguish groups. Clinical phenotype was not a predictor of long-term disability, and there were no differences in SDOH between phenotypes. This study suggests the mechanism of some clinical phenotype post-TBI are from TBI severity or patient premorbid history rather than SDOH.

    Speakers
    (Speaker) Maral Sakayan, MD