Publications by authors named "Ava Puccio"
Background: Acute intoxication is common in patients evaluated for traumatic brain injury (TBI). However, the effect of elevated blood alcohol levels (BALs) on the diagnostic accuracy of FDA-cleared biomarkers for evaluating traumatic intracranial injury on computed tomography (CT) scan, namely, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), has not been well studied.
Methods: We investigated the effect of significantly elevated (>300 mg/dL) and modestly elevated BAL (81-300 mg/dL) at emergency department presentation on the diagnostic accuracy of GFAP and UCH-L1 for predicting a positive CT in patients presenting to 18 U.
Predictive value of platelet function assays in traumatic brain injury patients on antiplatelet therapy.
J Trauma Acute Care Surg
February 2025
Introduction: Traumatic brain injury (TBI) patients on antiplatelet therapy face higher mortality because of impaired platelet function, which may be treated by platelet transfusion. The value of testing platelet function in this cohort remains controversial. We aimed to evaluate the relationship between platelet function assays and outcomes in TBI patients on antiplatelet therapy receiving platelet transfusions.
View Article and Find Full Text PDFObjective: To determine the feasibility, efficacy, and safety of cold stored compared to room temperature platelet transfusion in patients with traumatic brain injury.
Summary Background Data: Data demonstrating the safety and efficacy of cold stored platelet transfusion are lacking following traumatic brain injury.
Methods: A phase 2, randomized, open label, clinical trial was performed at a single U.
Background: Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery.
Methods: The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014-2018; ClinicalTrials.
The purpose of this study was to assess the performance of predictive blood biomarkers for responsiveness to targeted treatments for chronic psychological issues years after traumatic brain injury (TBI). Targeted Evaluation Action and Monitoring of TBI was a prospective 6-month interventional trial of participants with chronic TBI sequelae ( = 95). Plasma biomarkers were analyzed pre-intervention: glial fibrillary acidic protein (GFAP), tau, hyperphosphorylated tau Thr231 (p-Tau), von Willebrand factor (vWF), brain lipid-binding protein (BLBP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), vascular endothelial growth factor-a (VEGFa), and claudin-5 (CLDN5).
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- Traumatic brain injury (TBI) is a big problem worldwide, causing many deaths and disabilities, and there aren't great treatments to help recovery.
- Researchers studied whether TBI shares similar causes with other brain conditions, like Alzheimer's and schizophrenia, to find new treatment ideas.
- They found specific brain pathways related to TBI recovery that might also be important for those other conditions, especially pathways dealing with important brain chemicals like serotonin and acetylcholine.
Activation of the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome is a moderating factor between obesity and cognitive impairment in animals, but this has never been tested in humans following mild traumatic brain injury (mTBI). This is a retrospective cohort analysis of subjects enrolled at a single level 1 trauma center (n = 172). Participants completed Trail Making Test Part A and B (TMT-A and B) at six- and twelve-months, Blood samples were obtained within 24 h of mTBI and apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), caspase-1, interleukin-18 (IL-18), and IL-1β were assayed.
View Article and Find Full Text PDFObjectives: An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort.
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- Traumatic brain injury (TBI) and hemorrhage significantly contribute to trauma-related fatalities, especially in patients with polytrauma, leading researchers to explore better diagnostic and prognostic methods.
- The study utilized blood samples from a cohort to assess the predictive ability of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) levels in patients experiencing hemorrhagic shock, with or without TBI, through classification tree analysis.
- Results indicated that GFAP levels, particularly greater than 286 pg/ml at patient arrival, effectively predicted TBI presence and associated outcomes, whereas UCH-L1 did not show significant predictive value in the studied scenarios.
Management of severe traumatic brain injury (sTBI) typically involves the use of sedation, which inherently results in benefits and risks. The cytochrome P450 enzyme CYP2B6 is involved in the biotransformation of particular drug classes, including many intravenous sedatives. Variants of the gene can lead to decreased systemic clearance of some sedatives, including propofol.
View Article and Find Full Text PDFBackground: Assessing pupil size and reactivity is the standard of care in neurocritically ill patients. Anisocoria observed in critically ill patients often prompts further investigation and treatment. This study explores anisocoria at rest and after light stimulus determined using quantitative pupillometry as a predictor of discharge modified Rankin Scale (mRS) scores.
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- * The study involved 89 severe TBI patients, primarily male and Caucasian, and measured long-term functional outcomes using the Glasgow Outcome Scale (GOS) at multiple time points (3, 6, 12, and 24 months).
- * Results indicated that patients with an RSS score of 3 or lower had better survival rates and more favorable long-term outcomes compared to those with higher RSS scores, highlighting the score's predictive value for long-term recovery.
Background: Traumatic brain injury (TBI) with skull fractures parallel to or crossing venous sinuses is a recognized risk factor for traumatic cerebral venous sinus thrombosis (tCVST). Despite the recognition of this traumatic pathology in the literature, no consensus regarding management has been achieved. This study aimed to evaluate the impact of tCVST on TBI outcomes and related complications.
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- The Glasgow Outcome Scale-Extended (GOS-E) is used to assess outcomes from severe brain injuries but is not very accurate in predicting results.
- Scientists looked at blood markers that might help predict how patients with traumatic brain injury (TBI) will do after their injury.
- They found that certain markers, like GFAP, were better at predicting outcomes early on, while others like total Tau were not as helpful at six months after the injury.
The NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome has been associated with worse outcomes from severe traumatic brain injury (TBI). The NLRP3 inflammasome is also strongly associated with other pro-inflammatory conditions, such as obesity. Little is known about the potential effect of mild TBI (mTBI) on the NLRP3 inflammasome and the extent to which modifying factors, such as obesity, may augment the inflammatory response to mTBI.
View Article and Find Full Text PDFObjective: The International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticosteroid Randomization After Significant Head Injury (CRASH) prognostic models for mortality and outcome after traumatic brain injury (TBI) were developed using data from 1984 to 2004. This study examined IMPACT and CRASH model performances in a contemporary cohort of US patients.
Methods: The prospective 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years 2014-2018) enrolled subjects aged ≥ 17 years who presented to level I trauma centers and received head CT within 24 hours of TBI.
Isolated traumatic subarachnoid hemorrhage (tSAH) after traumatic brain injury (TBI) on head computed tomography (CT) scan is often regarded as a "mild" injury, with reduced need for additional workup. However, tSAH is also a predictor of incomplete recovery and unfavorable outcome. This study aimed to evaluate the characteristics of CT-occult intracranial injuries on brain magnetic resonance imaging (MRI) scan in TBI patients with emergency department (ED) arrival Glasgow Coma Scale (GCS) score 13-15 and isolated tSAH on CT.
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- Blood levels of GFAP and UCH-L1 have FDA approval to help decide if a brain CT scan is needed shortly after a suspected TBI, specifically within the first 12 hours.
- This study sought to explore if the usefulness of these biomarkers extends beyond 12 hours for patients with a Glasgow Coma Scale score of 13-15, involving a large cohort from 18 trauma centers.
- Results showed GFAP is effective for predicting the necessity of a brain CT scan even at 14 days after injury, while other markers like UCH-L1 did not demonstrate strong predictive accuracy.
Article Synopsis
- Cognitive dysfunction is frequently observed after traumatic brain injury (TBI), with a clear link between TBI severity and the extent of cognitive issues in the long term (around 6 months post-injury).
- A study aimed to examine the occurrence of cognitive dysfunction across various cognitive areas like processing speed, memory, and executive function in TBI patients from trauma centers.
- The research included 1,057 TBI patients and 327 control participants, revealing that many TBI patients performed comparably to controls, with around 49% to 67% demonstrating cognitive performance within 1.5 standard deviations of the control group.
Background: Anisocoria (unequal pupil size) has been defined using cut points ranging from greater than 0.3 mm to greater than 2.0 mm for absolute difference in pupil size.
View Article and Find Full Text PDFImportance: One traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited.
Objective: To investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years.
Invasive neuromonitoring is a bedrock procedure in neurosurgery and neurocritical care. Intracranial hypertension is a recognized emergency that can potentially lead to herniation, ischemia, and neurological decline. Over 50,000 external ventricular drains (EVDs) are performed in the United States annually for traumatic brain injuries (TBI), tumors, cerebrovascular hemorrhaging, and other causes.
View Article and Find Full Text PDFObjectives: Obesity is associated with chronic inflammation, which may impact recovery from mild traumatic brain injury (mTBI). The objective was to assess the role of obesity in recovery of symptoms, functional outcome and inflammatory blood biomarkers after mTBI.
Methods: TRACK-TBI is a prospective study of patients with acute mTBI (Glasgow Coma Scale=13-15) who were enrolled ≤24 hours of injury at an emergency department of level 1 trauma centres and followed for 12 months.