Benefits of Green Tea

Researchers from the University of California have published a new study validating prediction rules for identifying children at very low risk for clinically-important traumatic brain injuries for whom CT can routinely be obviated.  The researchers, noting that CT imaging of head injured children has the risk of radiation-induced malignancy, aim to identify children at very low risk of clinically-important TBI for whom CT scans might be unnecessary.  The research utilized patients under the age of 18 presenting with 24 hours of head trauma with Glasgow Coma Scale scores between 14-15 in 25  North American emergency departments.
 
The researchers analyzed over 42,000 children, obtaining CT scans on approximately 15,000 patients.  Of those, clinically-important TBI occurred in about one percent (376) and of those, 60 underwent neurosurgery.  The researchers concluded that for children younger than two years who had normal mental status, no scalp hematoma except frontal, no loss of consciousness or loss of consciousness for less than five seconds, non-severe injury mechanism, no palpable skull fracture and acting normally according to the parents, had a negative predictive value for clinically-important traumatic brain injury.  For children aged two years and older, the prediction rule with normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture and no severe headache had a negative predictive value of 99.95 percent and sensitivity of 96.8 percent.  Neither rule missed neurosurgery in the validation populations.
 
The study was funded by the Emergency Medical Services for Children Programme of the Maternal and Child Health Bureau, and the Maternal and Child Health Bureau Research Programme, Health Resources and Services Administration, US Department of Health and Human Services.  The study was published in the Lancet and can be found onilne here.

As I mentioned in a previous post, The International Brain Injury Association will hold the Eighth World Congress on Brain Injury in Washington, DC, March 10-14, 2010. The preliminary program for the Congress  is now available for viewing on-line, and includes a scientific program with over 100 world renowned experts in the field of brain injury presenting on a variety of topics across the continuum of care. The IBIA has also planned other special features including workshops, panels, scientific poster and paper presentations and candlelight sessions with experts.

To access the preliminary program, or for additional information on the IBIA’s World Congress, please visit their website online here.

 

A recent report from the journal Neuropsychology argues that the common misconception that brains in older individuals are smaller than those of younger people is false. Researchers state that this theory was derived from the way in which studies have been conducted over the years. In the past, research was gathered from studies which look at thousands of MRI’s from people who are already ill. These studies do not screen out people who had undetected and slowly growing brain diseases. 

The new study observed older individuals who were healthy for nine years prior to the test and found that those without a pre-existing medical condition had relatively similar sized brains as those of younger people. Those who did have a pre-existing medical condition did have a brain slightly smaller than those healthy individuals.

I recently read an interesting article in “Brain” a Journal of Neurology.  The article is entitled “Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability”.  The paper was authored by Marcus H. Heitger and his colleagues in Christchurch, New Zealand.

The researchers examined whether post-concussion syndrome patients continued to show disparities in eye movement function at 3-5 months following mild traumatic brain injury as compared with patients who had a good recovery.  The researchers “hypothesized that eye movements might provide sensitive and objective functional markers of ongoing cerebral impairment in post-concussion syndrome.  Thirty-six PCS participants were matched with thirty-six controls (patients of similar injury severity but good recovery) on reflexive, anti- and self-paced saccades, memory-guided sequences and smooth pursuit.

The researchers found that the PCS group performed worse on anti-saccades, self-paced saccades, memory-guided sequences and smooth pursuit, suggesting problems and response inhibition, short-term spatial memory, motor-sequence programming, visuospatial processing and visual attention. 

The researchers concluded that compared with neuropsychological testing, eye movements were more likely to be markedly impaired in post-concussion syndrome cases with high symptom overload.  “Poorer eye movement function, and particularly poorer subcortical oculomotor function, correlated more with post-concussive symptom load and problems on activities of daily living whilst poorer neuropsychological function exhibited slightly better correlations with measures of mental health.”

Once again, this is another important research study indicating that patients with post-concussion syndrome do not all recover within a short period of time and provides objective evidence of such injury.

In prior blog entries, I have discussed various literature regarding Green’s word memory test.  I have also discussed in the past the need for journals to require its authors to report conflicts of interest.
 
I recently received a copy of the August 2009 issue of Brain Injury, the Official Research Journal of the International Brain Injury Association.  Included in that issue was an article by Paul Green entitled “Examining False Positives on the Word Memory Test in Adults with Mild Traumatic Brain Injury.”  At the end of the article, a “Declaration of Interest” was included.  There, it stated, “Dr. Paul Green is the inventor, author and copyright owner of the Word Memory Test, the medical symptom validity test and a nonverbal medical symptom validity test.  Drs. Flaro and Courtney have no financial interest in these tests.”
 
Unfortunately, Dr. Green failed to acknowledge in his Declaration of Interest, the amount of forensic work in which he is involved and the amount of income he receives as a result of that work.
 
In the body of the article, under the methodology section of the article, he writes,
 
 “Between 1996 and 2008, 1,856 consecutive cases were referred to the first author’s private practice for neuropsychological assessment in the context of workers’ compensation claims, insurance disability claims or litigation.”
 
Thus, it is clear, that an extensive portion of Dr. Green’s income is derived from forensic work.  How much of that work is on behalf of plaintiffs and how much is on behalf of the insurance industry and self-funded major corporations.Unfortunately, neither the article nor the declaration provides the reader with any details regarding a breakdown of the percentage of the 1,856 cases as to whether or not they were done on behalf of the injured plaintiff or the defendant who is responsible for the harm it caused.
 
Hopefully, in future issues of Brain Injury as well as other journals, conflicts of interests and declarations of interest will include more information regarding the amount of forensic work performed by the authors.