Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study

An interpretative phenomenological analysis of the psychosexual identity development in adolescent and young adult survivors of testicular cancer

BACKGROUND

Qualitative research has explored how some testicular cancer survivors (TCS) experience the psychological impacts of diagnosis and treatment. More research into the impacts of testicular cancer (TC) on adolescent and young adults (AYA) is needed due to the critical period of identity development. The present study aimed to explore how AYA with TC appraise and make sense of their experience and to develop a greater understanding of psychosexual identity development in AYA TCS.

METHOD

Eight AYA TCS were interviewed. The results were analysed using Interpretative Phenomenological Analysis. The questions explored the experiences relating to diagnosis and treatment, how it affected their psychosexual identity development (e.g., sexual relationships and self-image) and the meanings attached to the experiences.

ANALYSIS

Four Group Experiential Themes were developed from the data; 'Dealing with the shock', 'Fear and weight of responsibility', 'those closest to me' and 'sense of change'.

DISCUSSION

The AYA TCS experiences may result in adoption of traditional masculine traits (e.g., stoicism) or abandonment of traditionally masculine traits (E.g. violence and aggression). AYA TCS also described feelings of insecurity when compared to other men. Psychology input could help manage stoicism and feelings of inferiority when compared to men with two testicles.

The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience

Objectives

To describe the use and outcomes of the neurological wake-up test (NWT) in pediatric severe traumatic brain injury (pTBI).

Design

Retrospective single-center observational cohort study.

Setting

Medical-surgical tertiary pediatric intensive care unit (PICU) in a university medical center and Level 1 Trauma Center.

Patients

Children younger than 18 years with severe TBI [i.e., Glasgow Coma Scale (GCS) of ≤8] admitted between January 2010 and December 2020. Subjects with non-traumatic brain injury were excluded.

Measurements and main results

Of 168 TBI patients admitted, 36 (21%) met the inclusion criteria. Median age was 8.5 years [2 months to 16 years], 5 patients were younger than 6 months. Median initial Glasgow Coma Scale (GCS) and Glasgow Motor Scale (GMS) was 6 [3-8] and 3 [1-5]. NWTs were initiated in 14 (39%) patients, with 7 (50%) labelled as successful. Fall from a height was the underlying injury mechanism in those seven. NWT-failure occurred in patients admitted after traffic accidents. Sedation use in both NWT-subgroups (successful vs. failure) was comparable. Cause of NWT-failure was non-arousal (71%) or severe agitation (29%). Subjects with NWT failure subsequently had radiological examination (29%), repeat NWT (43%), continuous interruption of sedation (14%) or intracranial pressure (ICP) monitoring (14%). The primary reason for not doing NWTs was intracranial hypertension in 59%. Compared to the NWT-group, the non-NWT group had a higher PRISM III score (18.9 vs. 10.6), lower GCS/GMS at discharge, more associated trauma, and circulatory support. Nine patients (25%) died during their PICU admission, none of them had an NWT.

Conclusion

We observed limited use of NWTs in pediatric severe TBI. Patients who failed the NWT were indistinguishable from those without NWT. Both groups were more severely affected compared to the NWT successes. Therefore, our results may indicate that only a select group of severe pTBI patients qualify for the NWT.

Association between short-term air pollution exposure and traumatic intracranial hemorrhage: pilot evidence from Taiwan

Introduction

The detrimental effects of air pollution on the brain are well established. However, few studies have examined the effect of air pollution on traumatic brain injury (TBI). This pilot study evaluated the association between short-term air pollution exposure and traumatic intracranial hemorrhage (TIH).

Methods

Hospital data of patients with TBI following road traffic accidents were retrospectively collected from the electronic medical records at five trauma centers in Taiwan between 1 January and 31 December 2017. TIH was employed as an outcome measure. All road accident locations were geocoded, and air quality data were collected from the nearest monitoring stations. Air pollutants were entered into five multivariable models. A sensitivity analysis was performed on patients who are vulnerable to suffering TBI after road accidents, including motorcyclists, bicyclists, and pedestrians.

Results

Among 730 patients with TBI, 327 had TIH. The ages of ≥65 [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.85-5.70], 45-64 (OR, 2.61; 95% CI, 1.64-4.15), and 25-44 (OR, 1.79; 95% CI, 1.13-2.84) years were identified as significant risk factors in the multivariable analysis. In the best-fit multivariable model, exposure to higher concentrations of particulate matter ≤ 2.5 μm in aerodynamic diameter (PM_2.5) was associated with an elevated TIH risk (OR, 1.50; 95% CI, 1.17-1.94). The concentration of nitrogen oxides (NO_X) did not increase the risk of TIH (OR, 0.45; 95% CI, 0.32-0.61). After categorizing the air pollution concentration according to quartile, the trend tests in the multivariate model showed that the concentrations of PM_2.5 and NO_X were significant (p = 0.017 and p < 0.001, respectively). There was a negative borderline significant association between temperature and TIH risk (OR, 0.75; 95% CI, 0.56-1.00, p = 0.05). Notably, the single-vehicle crash was a significant risk factor (OR, 2.11; 95% CI, 1.30-3.42) for TIH.

Discussion

High PM_2.5 concentrations and low temperatures are risk factors for TIH in patients with TBI. High NO_X concentrations are associated with a lower TIH risk.

Biomechanics of Traumatic Head and Neck Injuries on Women: A State-of-the-Art Review and Future Directions

The biomechanics of traumatic injuries of the human body as a consequence of road crashes, falling, contact sports, and military environments have been studied for decades. In particular, traumatic brain injury (TBI), the so-called "silent epidemic", is the traumatic insult responsible for the greatest percentage of death and disability, justifying the relevance of this research topic. Despite its great importance, only recently have research groups started to seriously consider the sex differences regarding the morphology and physiology of women, which differs from men and may result in a specific outcome for a given traumatic event. This work aims to provide a summary of the contributions given in this field so far, from clinical reports to numerical models, covering not only the direct injuries from inertial loading scenarios but also the role sex plays in the conditions that precede an accident, and post-traumatic events, with an emphasis on neuroendocrine dysfunctions and chronic traumatic encephalopathy. A review on finite element head models and finite element neck models for the study of specific traumatic events is also performed, discussing whether sex was a factor in validating them. Based on the information collected, improvement perspectives and future directions are discussed.

The relationship between road traffic collision dynamics and traumatic brain injury pathology

Road traffic collisions are a major cause of traumatic brain injury. However, the relationship between road traffic collision dynamics and traumatic brain injury risk for different road users is unknown. We investigated 2065 collisions from Great Britain's Road Accident In-depth Studies collision database involving 5374 subjects (2013-20). Five hundred and ninety-five subjects sustained a traumatic brain injury (20.2% of 2940 casualties), including 315 moderate-severe and 133 mild-probable injuries. Key pathologies included skull fracture (179, 31.9%), subarachnoid haemorrhage (171, 30.5%), focal brain injury (168, 29.9%) and subdural haematoma (96, 17.1%). These results were extended nationally using >1 000 000 police-reported collision casualties. Extrapolating from the in-depth data we estimate that there are ∼20 000 traumatic brain injury casualties (∼5000 moderate-severe) annually on Great Britain's roads, accounting for severity differences. Detailed collision investigation allows vehicle collision dynamics to be understood and the change in velocity (known as delta-V) to be estimated for a subset of in-depth collision data. Higher delta-V increased the risk of moderate-severe brain injury for all road users. The four key pathologies were not observed below 8 km/h delta-V for pedestrians/cyclists and 19 km/h delta-V for car occupants (higher delta-V threshold for focal injury in both groups). Traumatic brain injury risk depended on road user type, delta-V and impact direction. Accounting for delta-V, pedestrians/cyclists had a 6-times higher likelihood of moderate-severe brain injury than car occupants. Wearing a cycle helmet during a collision was protective against overall and mild-to-moderate-to-severe brain injury, particularly skull fracture and subdural haematoma. Cycle helmet protection was not due to travel or impact speed differences between helmeted and non-helmeted cyclist groups. We additionally examined the influence of the delta-V direction. Car occupants exposed to a higher lateral delta-V component had a greater prevalence of moderate-severe brain injury, particularly subarachnoid haemorrhage. Multivariate logistic regression models created using total delta-V value and whether lateral delta-V was dominant had the best prediction capabilities (area under the receiver operator curve as high as 0.95). Collision notification systems are routinely fitted in new cars. These record delta-V and automatically alert emergency services to a collision in real-time. These risk relationships could, therefore, inform how routinely fitted automatic collision notification systems alert the emergency services to collisions with a high brain injury risk. Early notification of high-risk scenarios would enable quicker activation of the highest level of emergency service response. Identifying those that require neurosurgical care and ensuring they are transported directly to a centre with neuro-specialist provisions could improve patient outcomes.

Sedation-Induced Burst Suppression Predicts Positive Outcome Following Traumatic Brain Injury

While electroencephalogram (EEG) burst-suppression is often induced therapeutically using sedatives in the intensive care unit (ICU), there is hitherto no evidence with respect to its association to outcome in moderate-to-severe neurological patients. We examined the relationship between sedation-induced burst-suppression (SIBS) and outcome at hospital discharge and at 6-month follow up in patients surviving moderate-to-severe traumatic brain injury (TBI). For each of 32 patients recovering from coma after moderate-to-severe TBI, we measured the EEG burst suppression ratio (BSR) during periods of low responsiveness as assessed with the Glasgow Coma Scale (GCS). The maximum BSR was then used to predict the Glasgow Outcome Scale extended (GOSe) at discharge and at 6 months post-injury. A multi-model inference approach was used to assess the combination of predictors that best fit the outcome data. We found that BSR was positively associated with outcomes at 6 months (P = 0.022) but did not predict outcomes at discharge. A mediation analysis found no evidence that BSR mediates the effects of barbiturates or propofol on outcomes. Our results provide initial observational evidence that burst suppression may be neuroprotective in acute patients with TBI etiologies. SIBS may thus be useful in the ICU as a prognostic biomarker.

Trauma Surgeon-Led and Funded Injury Prevention Program Decreases Admission for Motorcycle Crash Injuries

BACKGROUND

Unhelmeted motorcyclists injured in states with lax or poorly enforced helmet safety laws are frequently seen in rural trauma centers. A trauma surgeon started a comprehensive injury prevention and research fund with outreach to a three-state trauma center catchment area promoting injury prevention at area high schools and local communities. We hypothesized that unhelmeted riders would have more severe head injuries and fatalities than helmeted riders.

METHODS

A trauma registry review of 708 injured motorcycle riders over an 11-year period examined demographics, helmet use, and clinical outcomes of helmeted and unhelmeted riders. A full-time injury prevention coordinator collaborating with law enforcement provided electronic and mechanical simulations with discussions regarding helmet use, alcohol avoidance, and responsible motorcycle riding for area high school students. This program coincided with the second half of our 11-year study. Multiple regression analysis evaluated predictors for head injury and death.

RESULTS

Unhelmeted motorcyclists suffered worse head injuries, (OR 8.8, CI 1.6-2.4, P < .001), more severe overall injury (OR 10, CI 12.7-18.6, P < .001), and higher mortality (OR 2.7, CI .02-.15, P < .001). Local motorcycle-related trauma center admissions and deaths have stabilized in recent years while statewide motorcycle crashes have increased (P < .05).

DISCUSSION

Unhelmeted motorcyclists suffer worse head injuries and mortality rates. Physician-led outreach efforts for injury prevention may be effective. Trauma surgeons have ongoing opportunities to promote responsible motorcycle riding for schools and local communities.

A retrospective registry analysis of the transport-related health burden of wheeled recreational devices in Queensland, Australia

OBJECTIVE

Evaluate injury patterns from wheeled recreational devices (WRD) in the public space and explore risk factors for hospital admission.

METHOD

A cross-sectional analysis of WRD injury prevalence and risk factors for hospital admissions was conducted using data from the Queensland Injury Surveillance Unit (QISU) database for 2007 to 2017. Descriptive statistics and a log-binomial regression model were used to calculate adjusted relative risk for hospital admission.

RESULTS

Most WRD injury in the public space was related to stand-alone WRD injury events such as falls, with few reported WRD users being hit by vehicles from 2007 to 2017. Stand-alone WRD injury events had a higher independent risk of hospital admissions when injured in the head/neck/face (RR 2.08, 95%CI 1.6 to 2.8, p<0.001), and when the injury was a fracture (RR 2.57, 95%CI 2.1 to 3.3, p<0.001) or a brain injury (RR 3.19, 95%CI 2.5 to 4.1, p<0.001).

CONCLUSION

Head, brain and facial injuries and fractures are leading preventable factors for hospital admissions due to WRD injury. These types of injuries generate a preventable burden to the health system. Implications for public health: The results support the need to consider legislation regarding mandatory helmet use for non-motorised WRD when used on public roads and footpaths, while further research is conducted. This strategy could reduce the long-term health outcomes associated with head, face and brain injury in young commuters.

Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review

This systematic review provides a comprehensive, up-to-date summary of traumatic brain injury (TBI) epidemiology in Europe, describing incidence, mortality, age, and sex distribution, plus severity, mechanism of injury, and time trends. PubMed, CINAHL, EMBASE, and Web of Science were searched in January 2015 for observational, descriptive, English language studies reporting incidence, mortality, or case fatality of TBI in Europe. There were no limitations according to date, age, or TBI severity. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. Data were presented narratively. Sixty-six studies were included in the review. Country-level data were provided in 22 studies, regional population or treatment center catchment area data were reported by 44 studies. Crude incidence rates varied widely. For all ages and TBI severities, crude incidence rates ranged from 47.3 per 100,000, to 694 per 100,000 population per year (country-level studies) and 83.3 per 100,000, to 849 per 100,000 population per year (regional-level studies). Crude mortality rates ranged from 9 to 28.10 per 100,000 population per year (country-level studies), and 3.3 to 24.4 per 100,000 population per year (regional-level studies.) The most common mechanisms of injury were traffic accidents and falls. Over time, the contribution of traffic accidents to total TBI events may be reducing. Case ascertainment and definitions of TBI are variable. Improved standardization would enable more accurate comparisons.

Estimation of the burden of out-of-hospital traumatic cardiac arrest in Karachi, Pakistan, using a cross-sectional capture-recapture analysis

Background

The burden of trauma-related-out-of-hospital cardiac arrest (OHCA) in developing countries like Pakistan remains largely unexplored due to a lack of organized pre-hospital systems. In order to estimate the burden, we used a two-sample capture-recapture method which has been used in several domains to estimate difficult-to-count populations.

Methods

We obtained 3-month data from two sources: Records of two major EMS (emergency medical services) systems and five major hospitals providing coverage to the city’s population. All adults with traumatic OHCA were included. Information on variables such as name, age, gender, date and time of arrest, cause of arrest, and destination hospital were obtained for these cases and data were compared to obtain a matched sample. Utilizing an equation and different levels of restrictive criteria, estimates were obtained for burden.

Results

The EMS records reported 788 and hospital records reported 344 cases of traumatic OHCA. The capture-recapture analysis estimated the annual traumatic OHCA incidence as 45.7/100,000 (95% CI: 44.2 to 47.3). Estimation of the burden from individual hospital or EMS records underestimated and calculated only 14.6% and 33.9% of the total burden, respectively. Most of the traumatic arrest victims had gunshot wound (GSW) (65.2%) followed by road traffic injuries (RTI) (20.8%).

Conclusion

The actual burden of traumatic OHCA in Pakistan is larger than the burden reported by either the hospitals or EMS services alone. Most of the cases occurred due to GSW and RTI. A multipronged approach is required to manage the problem; from prevention to developing organized trauma care systems and training lay responders in pre-hospital trauma care is vital.

Burden of fractures in France: incidence and severity by age, gender, and site in 2016

PURPOSE

Fractures are common events, but the exact incidence and severity of fractures have not been clearly determined for most anatomical sites. We estimated the incidence and severity of fractures in France regardless of the anatomical site.

METHODS

Observational cross-sectional study in France in 2016 based on the national health data system. All incident fractures in patients 20 years and older were included. We determined the anatomical fracture site (12 sites) and the severity using a 4-point scale (outpatient care, hospitalization, surgery, and in-hospital death).

RESULTS

We identified 562,094 incident fractures, predominantly occurring in women (319,858: 56.9%); with a mean age of 63.6 years, and an exponential increase after the age of 70 years. Distal upper limb (172,591: 30.7%), distal lower limb (84,602: 15.1%), and femoral neck (78,766: 14.0%) accounted for more than one-half of all fractures. Sex and age of onset distributions varied widely according to fracture sites, with earlier onset for distal lower limb fractures (mean age: 54.2 years) and distal upper limb fractures (mean age: 55.2 years) with a men predominance for skull fractures. Only 105,165 (18.7%) fractures were treated on an outpatient basis; 11,913 (2.1%) in-hospital deaths occurred in patients with a mean age of 79.5 years. High mortality was observed for skull (12.9%), rib (4.9%), and femoral fractures (femoral neck 4.3% and proximal lower limb 4.2%).

CONCLUSION

We estimated the incidence of fractures in France by sex and anatomical site. We also showed that fractures remain common and serious life events, especially in older people.

The Cost Analysis of Patients with Traffic Traumatic Injuries Presenting to Emergency Department; a Cross-sectional Study

Introduction

Road traffic traumatic injuries are the leading cause of death especially among young men who are mostly vulnerable victims. This catastrophe is more complicated in low to middle-income countries.

Objective

This study assessed the financial costs of traffic casualties in a level-1 trauma university hospital.

Method

One thousand trauma patients presenting to the emergency department of Shohaday-e-Tajrish Hospital were included in the study. The prehospital and hospital costs as well as the expenses of physiotherapy, rehabilitation, outpatient visits and further surgical interventions were considered as direct expenses. The costs of productivity loss were estimated as indirect expenses.

Results

The direct and indirect costs were assessed 27.4% and 72.6% of total, respectively. The mean age of permanent disability was 43 years old. The average expenses of temporary and permanent disabilities were 2934.4 million rials, equal to 106 thousand $ (nearly 4.2 million rials or 153 $ per patient) and 23.9 billion rials, equal to 866.3 thousand $ (1.1 billion rials or 39.2 thousand $ per person), respectively.

Conclusion

The national burden of traffic injuries in Iran is significantly destructive as it consists of 2.19 % of Gross Domestic Product annually. Besides, young men are involved in most of the traffic accidents representing the need to establish rigorous preventive instructions and reduce human, and financial costs.

Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3-4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<-1 DS) or low IGF-1 (<-2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5-10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4-6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.

The Young Male Syndrome-An Analysis of Sex, Age, Risk Taking and Mortality in Patients With Severe Traumatic Brain Injuries

Higher risk taking is particularly characteristic for males between 15 and 35 years, the age when intrasexual competition is the strongest. This fitness-maximizing strategy, however, also has negative consequences; previous data revealed that males have a significantly higher tendency to die in accidents. This retrospective study aimed to assess whether age-related risk taking, often associated with the reproductive competition between males, and referred to as the Young Male Syndrome (YMS), may play a role in the high incidence of severe traumatic brain injury (sTBI) in young males. Derived from the available evidence and the main assumptions of the YMS, we expected that men, especially when they are in the age when their reproductive potential peaks, are more likely to suffer sTBI from highly risky behaviors that also lead to higher mortality. It was also expected that alcohol intoxication makes the demographic pattern of sTBI even more similar to what previous research on the YMS implies. We analyzed demographic data of patients with sTBI (N = 365) registered in a clinical database. To this end, we built Generalized Linear Mixed Models (GLMM) to reveal which of the demographic characteristics are the best predictors for risky behaviors leading to sTBI and death as a consequence of the injury. The data suggest that younger people acquired sTBI from riskier behaviors compared to members of older age groups, irrespective of their sex. Moreover, being male and being alcohol intoxicated also contributed significantly to risk-taking behavior. Mortality rate after the injury, however, increased with the age of the patient and did not depend on the riskiness of the behavior. The results indicate that the demographic distribution of the specific patient population in our focus cannot be simply explained by the YMS. However, higher incidence rates of males among the patients are in line with the core assumptions of the YMS. These data indicate that epidemiological studies should also take into consideration evolutionary theories and highlight the importance of age and sex specific prevention strategies.

Estimating the global incidence of traumatic brain injury

OBJECTIVE

Traumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.

METHODS

Open-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global Burden of Disease Study 2015 was applied to these two ratios to generate the incidence and estimated case volume of TBI for each WHO region and WB income group.

RESULTS

Relevant articles and registries were identified via systematic review; study quality was higher in the high-income countries (HICs) than in the low- and middle-income countries (LMICs). Sixty-nine million (95% CI 64-74 million) individuals worldwide are estimated to sustain a TBI each year. The proportion of TBIs resulting from road traffic collisions was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). The incidence of RTI was similar in Southeast Asia (1.5% of the population per year) and Europe (1.2%). The overall incidence of TBI per 100,000 people was greatest in North America (1299 cases, 95% CI 650-1947) and Europe (1012 cases, 95% CI 911-1113) and least in Africa (801 cases, 95% CI 732-871) and the Eastern Mediterranean (897 cases, 95% CI 771-1023). The LMICs experience nearly 3 times more cases of TBI proportionally than HICs.

CONCLUSIONS

Sixty-nine million (95% CI 64-74 million) individuals are estimated to suffer TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease. Head injury following road traffic collision is more common in LMICs, and the proportion of TBIs secondary to road traffic collision is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions with higher-quality data, specifically in North America and Europe.

Pediatric emergency department visits for pedestrian and bicyclist injuries in the US

Background

Despite reductions in youth pedestrian and bicyclist deaths over the past two decades, these injuries remain a substantial cause of morbidity and mortality for children and adolescents. There is a need for additional information on non-fatal pediatric pedestrian injuries and the role of traumatic brain injury (TBI), a leading cause of acquired disability.

Methods

Using a multi-year national sample of emergency department (ED) records, we estimated annual motorized-vehicle related pediatric pedestrian and bicyclist (i.e. pedalcyclist) injury rates by age and region. We modeled in-hospital fatality risk controlling for age, gender, injury severity, TBI, and trauma center status.

Results

ED visits for pediatric pedestrian injuries declined 19.3% (95% CI 16.8, 21.8) from 2006 to 2012, with the largest decreases in 5-to-9 year olds and 10-to-14 year olds. Case fatality rates also declined 14.0%. There was no significant change in bicyclist injury rates.

TBI was implicated in 6.7% (95% CI 6.3, 7.1) of all pedestrian and bicyclist injuries and 55.5% (95% CI 27.9, 83.1) of fatalities. Pedestrian ED visits were more likely to be fatal than bicyclist injuries (aOR = 2.4, 95% CI 2.3, 2.6), with significant additive interaction between pedestrian status and TBI.

Conclusions

TBI in young pedestrian ED patients was associated with a higher risk of mortality compared to cyclists. There is a role for concurrent clinical focus on TBI recovery alongside ongoing efforts to mitigate and prevent motor vehicle crashes with pedestrians and bicyclists. Differences between youth pedestrian and cycling injury trends merit further exploration and localized analyses, with respect to behavior patterns and interventions. ED data captures a substantially larger number of pediatric pedestrian injuries compared to crash reports and can play a role in those analyses.

Electronic supplementary material

The online version of this article (10.1186/s40621-017-0128-5) contains supplementary material, which is available to authorized users.

Brainstem injury in motor vehicle crashes

OBJECTIVE

This is a descriptive study of the frequency and risk for brainstem injury by crash type, belt use, and crash severity (delta-V). NASS-CDS electronic cases were reviewed to see whether the transition from vehicles without advanced airbags and seat belts and side airbags and curtains to vehicles with the safety technologies has influenced the risk for brainstem injury.

METHODS

1994-2013 NASS-CDS was analyzed to determine the number of brainstem injuries in nonejected adults (15+ years old) in vehicle crashes. Crashes were grouped by front, side, rear, and rollover. The effect of belt use was investigated. Light vehicles were included with model year (MY) 1994+. Occupants with severe head injury (Abbreviated Injury Scale [AIS] 4+) and Maximum Abbreviated Injury Scale (MAIS) 4+F injury were also determined. The risk for injury with standard errors was determined using the MAIS 0+F exposure by belt use and crash type. NASS-CDS electronic cases were studied with brainstem injury in 2001-2013 MY vehicles.

RESULTS

NASS-CDS indicates there are 872 ± 133 cases of brainstem injury per year. About 16.0% of AIS 4+ head injury involves the brainstem. For belted occupants, the highest risk for brainstem injury was in side impacts at 0.065 ± 0.010%. In contrast, the highest risk for brainstem injury was 0.310 ± 0.291% in rear impacts and 0.310 ± 0.170% in rollovers for unbelted occupants. The risk for brainstem injury increased with crash severity. The highest risk for brainstem injury was 3.54 ± 1.45% in crashes with >72 km/h (>45 mph) delta-V. Exponential functions fit the change in risk with delta-V. Eighteen NASS-CDS electronic cases showed that brainstem injury occurred in very severe collisions where the occupant experienced multiple injuries from intrusion or impact on vehicle structures stiffened by deformation.

CONCLUSIONS

The risk for brainstem injury in belted occupants has remained essentially constant over 20 years, whereas the risk for MAIS 4+F injury has declined 38.3%. The prevention of brainstem injuries must address the extreme speed of collisions and weight mismatches that overwhelm structures, seat belts, frontal airbags, side airbags, and curtains in modern vehicles.

Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study

Importance

Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective

To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review

Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings

Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions and Relevance

Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

History of traumatic brain injury in prison populations: A systematic review

Traumatic brain injury (TBI) can lead to cognitive, behavioural and social impairments. The relationship between criminality and a history of TBI has been addressed on several occasions.

OBJECTIVE

The objective of this review was to present an update on current knowledge concerning the existence of a history of TBI in prison populations.

METHODS

PubMed and PsycINFO databases were searched for relevant papers, using the PRISMA guidelines. We selected papers describing TBI prevalence among incarcerated individuals and some that also discussed the validity of such studies.

RESULTS

Thirty-three papers were selected. The majority of the papers were on prison populations in Australia (3/33), Europe (5/33) and the USA (22/33). The selected studies found prevalence rates of the history of TBI ranging from 9.7% and 100%, with an average of 46% (calculated on a total population of 9342). However, the level of evidence provided by the literature was poor according to the French national health authority scale. The majority of the prisoners were males with an average age of 37. In most of the papers (25/33), prevalence was evaluated using a questionnaire. The influence of TBI severity on criminality could not be analysed because of a lack of data in the majority of papers. Twelve papers mentioned that several comorbidities (mental health problems, use of alcohol…) were frequently found among prisoners with a history of TBI. Two papers established the validity of the use of questionnaires to screen for a history of TBI.

CONCLUSION

These results confirmed the high prevalence of a history of TBI in prison populations. However, they do not allow conclusions to be drawn about a possible link between criminality and TBI. Specific surveys need to be performed to study this issue. The authors suggest ways of improving the screening and healthcare made available to these patients.

Helmet efficacy against concussion and traumatic brain injury: a review

Helmets are one of the earliest and most enduring methods of personal protection in human civilization. Although primarily developed for combat purposes in ancient times, modern helmets have become highly diversified to sports, recreation, and transportation. History and the scientific literature exhibit that helmets continue to be the primary and most effective prevention method against traumatic brain injury (TBI), which presents high mortality and morbidity rates in the US. The neurosurgical and neurotrauma literature on helmets and TBI indicate that helmets provide effectual protection against moderate to severe head trauma resulting in severe disability or death. However, there is a dearth of scientific data on helmet efficacy against concussion in both civilian and military aspects. The objective of this literature review was to explore the historical evolution of helmets, consider the effectiveness of helmets in protecting against severe intracranial injuries, and examine recent evidence on helmet efficacy against concussion. It was also the goal of this report to emphasize the need for more research on helmet efficacy with improved experimental design and quantitative standardization of assessments for concussion and TBI, and to promote expanded involvement of neurosurgery in studying the quantitative diagnostics of concussion and TBI. Recent evidence summarized by this literature review suggests that helmeted patients do not have better relative clinical outcome and protection against concussion than unhelmeted patients.

Family needs after brain injury: A cross cultural study

OBJECTIVE

The objective of this study was to explore differences by country in the importance of family needs after traumatic brain injury (TBI), as well as differences in met/unmet needs.

METHOD

Two hundred and seventy-one family members of an individual with TBI in Mexico, Colombia, Spain, Denmark, and Norway completed the Family Needs Questionnaire.

RESULTS

Eight of the ten needs rated as most important globally were from the Health Information subscale. Importance ratings on the Health Information, Professional Support, and Involvement With Care subscales were similar across countries, but Mexican family members rated Instrumental Support needs as less important than Colombian, Spanish, and Danish family members, and also rated their Community Support needs as less important than Danish and Spanish family members. Mexican family member's rated emotional support needs as less important than Colombian, Spanish, and Danish family members. Globally, the needs rated as most often met were from the Health Information subscale, and the most unmet needs were from the Emotional Support subscale.

CONCLUSION

Despite some similarities across countries several differences were identified, and these can help professionals to provide more culturally appropriate rehabilitation services for family members in order to improve informal care for TBI.

Prevalence of traumatic brain injury and epilepsy among prisoners in France: Results of the Fleury TBI study

OBJECTIVE

The first aim of this study was to estimate the prevalence of TBI and epilepsy in a French prison population and to study variables known to be associated with TBI. The second aim was to compare prisoners with and without a history of TBI.

PARTICIPANTS

All offenders (females, males and juveniles) admitted consecutively to Fleury-Mérogis prison over a period of 3 months were included in the study.

DESIGN

During the admission procedure, offenders were interviewed by healthcare staff using a self-reported questionnaire.

RESULTS

In all, 1221 prisoners were included. The rates of TBI and epilepsy were high, with a prevalence of 30.6% and 5.9%, respectively. Psychiatric care, anxiolytic and antidepressant treatment, use of alcohol and cannabis were all significantly higher among offenders with a history of TBI. Moreover, the number of times in custody and the total time spent in jail over the preceding 5 years were significantly higher among offenders with a history of TBI.

CONCLUSIONS

These results provide further evidence that specific measures need to be developed such as, first of all, screening for TBI upon arrival in prison.

Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study

Introduction

Traumatic brain injury (TBI) is a growing public health problem around the world, yet there is little information on the prevalence of head injury in low and middle income countries (LMICs). We utilised data collected by the 10/66 research group to investigate the lifetime prevalence of head injury in defined sites in low and middle income countries, its risk factors and its relationship with disability.

Methods

We analysed data from one-phase cross-sectional surveys of all residents aged 65 years and older (n = 16430) distributed across twelve sites in eight low and middle income countries (China, Cuba, Dominican Republic, India, Venezuela, Mexico, Peru, and Puerto Rico). Self-reported cases of head injury with loss of consciousness were identified during the interview. A sensitivity analysis including data provided by informants of people with dementia was also used to estimate the impact of this information on the estimates. Prevalence ratios (PR) from Poisson regressions were used to identify associated risk factors.

Results

The standardised lifetime prevalence of TBI ranged from 0.3% in China to 14.6% in rural Mexico and Venezuela. Being male (PR: 1.6, 95% CI: 1.29–1.82), younger (PR: 0.95, 95% CI: 0.92–0.99), with lower education (PR 0.91, 95% CI: 0.86–0.96), and having fewer assets (PR 0.92, 95% CI: 0.88–0.96), was associated with a higher prevalence of TBI when pooling estimates across sites.

Discussion

Our analysis revealed that the prevalence of TBI in LMICs is similar to that of developed nations. Considering the growing impact of TBI on health resources in these countries, there is an urgent need for further research.

Alcohol consumption, helmet use and head trauma in cycling collisions in Germany

Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions. The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany and to identify risk factors related to head trauma sustained in cycling accidents. The source used for the present analysis was the database of the German in-depth accident study (GIDAS). All cyclists who had been involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected. Logistic regression analyses were carried out to evaluate various aspects: alcohol consumption, helmet use, head trauma, and cyclist/accident characteristics. Female riders were less likely to have consumed alcohol (OR=0.23, 95% CI: 0.08-0.66); cyclists who did not wear a helmet were more likely to have consumed alcohol (OR=2.41, 95% CI: 1.08-5.38); cyclists who were not responsible for the collision were less likely to have consumed alcohol than those who were partially responsible for the accident (OR=0.22, 95% CI: 0.08-0.61). Cyclists involved in collisions with another vehicle, motorised or not, had a lower risk of suffering a head injury compared with those involved in single-vehicle accidents (OR=0.27, 95% CI: 0.12-0.62, and OR=0.08, 95% CI: 0.03-0.22, respectively). The prevention or limiting of alcohol consumption among cyclists and the corresponding testing of cyclists must be improved. Training initiatives on helmet protection should be encouraged.

Fatal motorcycle crashes: a growing public health problem in Cambodia

This study examines the risk characteristics of fatal motorcycle crashes in Cambodia over a 5-year period (2007-2011). Secondary data analyses were conducted using the Cambodia Road Crash and Victim Information System, the only comprehensive and integrated road crash surveillance system in the country. Researchers from the Centers for Disease Control and Prevention and Handicap International found that (1) males are dying in motorcycle crashes roughly seven times more frequently than females; (2) motorcyclist fatalities increased by about 30% from 2007 to 2011; (3) the motorcyclist death rates per 100,000 population increased from 7.4 to 8.7 deaths from 2007 to 2011; and (4) speed-related crashes and not wearing motorcycle helmet were commonly reported for motorcyclist fatalities at approximately 50% and over 80% through the study years, respectively. Additionally, this study highlights that Cambodia has the highest motorcycle death rate in South-East Asia, far surpassing Thailand, Malaysia, and Myanmar. By recognising the patterns of fatal motorcycle crashes in Cambodia, local road-safety champions and stakeholders can design targeted interventions and preventative measures to improve road safety among motorcyclists.

Crash risk factors related to individuals sustaining and drivers following traumatic brain injuries

OBJECTIVE

Some crashes result in drivers experiencing (or sustaining) a traumatic brain injury (TBI) while other crashes involve drivers that have already experienced a TBI. The objective of this study is to examine the factors that influence these two TBI crash groups.

METHODS

Data from the Iowa Department of Public Health's Brain Injury Registry and Department of Transportation's crash records were linked together and used in logistic regression models to predict the likelihood of a driver sustaining a TBI in a crash and those who drive after a TBI.

RESULTS

Between 2001 and 2006, there were 2382 crashes in which an individual sustained a TBI. As expected, a higher likelihood of sustaining a TBI was observed for motorcycle drivers who did not wear a helmet and in crashes that resulted in total or disabling vehicle damage. Focusing specifically on the post-TBI drivers (and not occupants), 1583 were involved in crashes. These post-TBI drivers were less likely to wear seatbelts or have passengers in the vehicle at the time of the crash, and were more likely to crash at night. Post-TBI drivers were also involved in significantly more multiple crashes (about 14%) when compared to drivers who have not experienced a TBI (about 10%) during the study period. When controlling for gender, date of injury, and severity of TBI (using Glasgow Coma Scale), individuals that sustained a TBI when they were younger were more likely to be involved in multiple crashes.

CONCLUSIONS

Different factors influence the crash likelihood for those that sustain a TBI in a crash and those that crash following a TBI. In general, post-TBI drivers have a higher occurrence of multiple crashes and this should be further explored to guide driver rehabilitation, evaluation, and training.

Charges associated with pediatric head injuries: a five year retrospective review of 41 pediatric hospitals in the US

Background:

Brain injuries are a significant public health problem, particularly among the pediatric population. Brain injuries account for a significant portion of pediatric injury deaths, and are the highest contributor to morbidity and mortality in the pediatric and young adult populations. Several studies focus on particular mechanisms of brain injury and the cost of treating brain injuries, but few studies exist in the literature examining the highest contributing mechanisms to pediatric brain injury and the billed charges associated with them.

Methods:

Data were extracted from the Pediatric Health Information System (PHIS) from member hospitals on all patients admitted with diagnosed head injuries and comparisons were made between ICU and non-ICU admissions. Collected data included demographic information, injury information, total billed charges, and patient outcome.

Results:

Motor vehicle collisions, falls, and assaults/abuse are the three highest contributors to brain injury in terms of total numbers and total billed charges. These three mechanisms of injury account for almost $1 billion in total charges across the five-year period, and account for almost half of the total charges in this dataset over that time period.

Conclusions:

Research focusing on brain injury should be tailored to the areas of the most pressing need and the highest contributing factors. While this study is focused on a select number of pediatric hospitals located throughout the country, it identifies significant contributors to head injuries, and the costs associated with treating them.

Geriatric Traumatic Brain Injury in China

Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality in China. The elderly population has the higher rates of TBI-related hospitalization and death. Traffic accidents are the major cause for TBI in all age groups except in the group of 75 years and older, in which stumbles occurred in nearly half of those who suffered TBI. Older age is known to negatively influence outcome after TBI. To date, investigators have identified a panel of prognostic factors that include initial Glasgow Coma Scale score, comorbidities, cerebrospinal fluid leakage, associated extracranial lesions, and other factors such as cerebral perfusion pressure on recovery after injury. However, these aspects remain understudied in elderly patients with TBI. In the absence of complete clinical data, predicting outcomes and providing good care of the elderly population with TBI remain limited. To address this significant public health issue, a refocusing of research efforts is justified to prevent TBI in this population and to develop unique care strategies for achieving better clinical outcomes of the patients with TBI.

Traumatic brain injuries caused by traffic accidents in five European countries: outcome and public health consequences

BACKGROUND

Road traffic accidents (RTAs) have been identified by public health organizations as being of major global concern. Traumatic brain injuries (TBIs) are among the most severe injuries and are in a large part caused by RTA. The objective of this article is to analyse the severity and outcome of TBI caused by RTA in different types of road users in five European countries.

METHODS

The demographic, severity and outcome measures of 683 individuals with RTA-related TBI from Austria, Slovakia, Bosnia, Croatia and Macedonia were analysed. Five types of road users (car drivers, car passengers, motorcyclists, bicyclists and pedestrians) were compared using univariate and multivariate statistical methods. Short-term outcome [intensive care unit (ICU) survival] and last available long-term outcome of patients were analysed.

RESULTS

In our data set, 44% of TBI were traffic related. The median age of patients was 32.5 years, being the lowest (25 years) in car passengers. The most severe and extensive injuries were reported in pedestrians. Pedestrians had the lowest rate of ICU survival (60%) and favourable long-term outcome (46%). Drivers had the highest ICU survival (73%) and car passengers had the best long-term outcome (59% favourable). No differences in the outcome were found between countries with different economy levels.

CONCLUSION

TBI are significantly associated with RTA and thus, tackling them together could be more effective. The population at highest risk of RTA-related TBI are young males (in our sample median age: 32.5 years). Pedestrians have the most severe TBI with the worst outcome. Both groups should be a priority for public health action.

Factors associated with road accidents among Brazilian motorcycle couriers

The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried out to investigate factors that were independently associated with the outcomes. Seven hundred and fifty motorcycle couriers, of mean age 29.5 years (standard deviation = 8.1 ), were included in the study. Young age (18 to 24 years compared to ≥25 years, odds ratio [OR] = 1.77) speeding (OR = 1.48), and use of cell phones while driving (OR = 1.43) were factors independently associated with reports of accidents. For serious accidents, there was an association with alternation of work shifts (OR = 1.91) and speeding (OR = 1.67). The characteristics associated with accidents—personal (young age), behavioral (use of cell phones while driving and speeding), and professional (speeding and alternation of work shifts)—reveal the need to adopt wide-ranging strategies to reduce these accidents, including better work conditions for these motorcyclists.

Traffic accidents with motorcycles and their relationship to mortality

This study characterizes traffic accidents involving motorcycles according to local conditions, data concerning the type of accident, date and time, and identifies among these variables those associated with the death of victims. This retrospective study uses data from traffic collision reports from 2004 and death records from the institute of forensic medicine. A total of 99.4% of the events occurred in urban areas, where illumination (87.4%), weather conditions (80.6%); and traffic signs (70.6%) were satisfactory. Collisions between motorcycles and cars or pickup trucks prevailed (55.5%), followed by motorcycle falls (18.0%). In relation to the type of collision, the highest percentage was observed in broadside collision category (35.2%). There were differences between the groups of fatalities and survivors in relation to the area and illumination in the collision’s site, in addition to the types of collision and impact. The conclusion is that local conditions and types of collision and impact stand out among the multiple variables defining the severity of accidents involving motorcycles.

The contribution of traumatic brain injury to the medical and economic outcomes of motor vehicle-related injuries in Ohio

OBJECTIVE

To describe traumatic brain injury (TBI) among injured roadway users. Aim 1 assessed the association of age, gender, alcohol/drug use, safety equipment use, type of roadway user, metropolitan area, and primary payer with motor vehicle-related TBI outcome. Aim 2 assessed the relationship of motor vehicle-related TBI and risk/protective factors with medical and economic outcomes.

METHODS

Population-level hospital and trauma databases from the Ohio Hospital Association and Ohio Department of Public Safety, respectively, were probabilistically linked for 2003 through 2006. Injured roadway users (motor vehicle occupants, motorcyclists, bicyclists, pedestrians, and others) were assessed for TBI, ventilator use, intensive care unit (ICU) admission, injury severity score (ISS), need for rehabilitation, death, and total hospital charges.

RESULTS

The odds of a motor vehicle-related TBI were greater among those not using safety equipment (OR=1.56). The interactions of alcohol/drug use by gender and of alcohol/drug use by location were significant. Sustaining a TBI increased the odds of requiring ventilation (OR=3.66), being admitted to the ICU (OR=2.51), having a high ISS (OR=4.24), requiring rehabilitation (OR=2.22), or death (OR=2.52). When compared with a non-TBI, total hospital charges increased by a factor of 1.35 for a TBI. Hospital charges were $46,441 on average for individuals who sustained a TBI, whereas mean hospital charges were $32,614 for patients with a non-TBI.

CONCLUSIONS

Among injured roadway users, individuals who sustain a TBI are more likely to require extensive medical care and have injuries resulting in death.

IMPACT ON INDUSTRY

Prevention strategies aimed at reducing alcohol use and increasing safety device use should be encouraged to reduce the burden of TBI.

Impact of early pharmacological treatment on cognitive and behavioral outcome after traumatic brain injury in adults: a meta-analysis

Early pharmacological treatment has the potential to reduce some of the disabling cognitive and behavioral problems that result from traumatic brain injury (TBI). Although a large number of treatments have been developed, clinical research has yielded inconsistent findings with respect to the effectiveness of these pharmacological treatments on cognitive and behavioral outcomes. Furthermore, their relative efficacy has not been evaluated, thereby hindering advances in the treatment of TBI. A meta-analysis of research that examined the impact of pharmacological treatments on cognitive and behavioral outcomes in the early stages after TBI between January 1980 and May 2008 was therefore undertaken. The PubMed and PsycINFO databases were searched using 35 terms. All articles were screened using detailed inclusion criteria. Weighted Cohen's d effect sizes, percent overlap statistics, and fail-safe N statistics were calculated for each pharmacological agent. Studies that used different experimental designs were examined separately. Eleven pharmacological treatments were investigated by 22 clinical studies, comprising 6472 TBI patients in the treatment groups and 6460 TBI controls. One dopamine agonist (amantadine) and 1 bradykinin antagonist (CP-0127 [Bradycor]) produced marked treatment benefits (d > or = 0.8) for a single measure of arousal (Glasgow Coma Scale). Notably, drug dosage and the measure chosen to assess outcome influenced the probability of finding a treatment benefit.

Pattern of craniofacial injuries in patients admitted to Tanta University Hospital--Egypt

The goal of this work was to determine the craniofacial injury patterns in hospitalized patients to facilitate the awareness, by identifying, describing and quantifying trauma for use in planning and evaluation of preventive programs. Two-hundred and fifty five patients with craniofacial injuries were registered at the department of neurosurgery in Tanta University Hospital. Data were collected including age, gender, medical history, cause of injury and type of injury, location and frequency of soft tissue injuries, skull fractures, facial bone fractures, brain injuries and concomitant injuries, patient symptoms, clinical signs and the radiological findings. The most common causes of craniofacial injuries were road traffic accidents, followed by activity of daily life and assaults. Gender distribution showed that, males were at higher risk than females with a ratio of 5.5/1. In total of skull fractures, 47.84% were fissure fracture and 24.31% were depressed fractures. In total of brain injuries, 7.06% for concussion, 4.71% for contusion, 10.98% for brain laceration, 14.12% for pneumocephalus and 36.47% for brain edema. Regression analysis revealed increased risk for skull fractures and brain injuries in traffic accidents were 84.78%, 94.20%, respectively, and 59.14%, 50.54% in activity of daily life, but the probability of soft tissue injuries increase in traffic accident and violence.

Costs, mortality likelihood and outcomes of hospitalized US children with traumatic brain injuries

PRIMARY OBJECTIVE

To examine the hospitalization costs and discharge outcomes of US children with TBI and to evaluate a severity measure, the predictive mortality likelihood level.

RESEARCH DESIGN

Data from the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were used to report the national estimates and characteristics of TBI-associated hospitalizations among US children < or =20 years of age. The percentage of children with TBI caused by motor vehicle crashes (MVC) and falls was calculated according to the predictive mortality likelihood levels (PMLL), death in hospital and discharge into long-term rehabilitation facilities. Associations with the PMLL, discharge outcomes and average hospital charges were examined.

RESULTS

In 2006, there were an estimated 58 900 TBI-associated hospitalizations among US children, accounting for $2.56 billion in hospital charges. MVCs caused 38.9% and falls caused 21.2% of TBI hospitalizations. The PMLL was strongly associated with TBI type, length of hospital stay, hospital charges and discharge disposition. About 4% of children with fall or MVC related TBIs died in hospital and 9% were discharged into long-term facilities.

CONCLUSION

The PMLL may provide a useful tool to assess characteristics and treatment outcomes of hospitalized TBI children, but more research is still needed.

Incidence of hospital-treated traumatic brain injury in the Oslo population

BACKGROUND

The aim of this prospective, population-based study is to present the incidence of hospital-treated traumatic brain injury (TBI) in Oslo, Norway, and to describe the severity of brain injuries and outcome of the patients' acute medical care.

METHODS

Data were obtained from hospital admission registers and medical records from May 2005 to May 2006. The initial severity of TBI was measured by the Glasgow Coma Scale. The region is urban with a population of 534,129.

RESULTS

The 445 patients identified represent an annual incidence of 83.3/100,000. The median age was 29 years. The male:female ratio was 1.8:1.0. The highest incidence of TBI hospitalizations was found in the elderly males and the youngest children. The most common causes of TBI were falls (51%) and transport accidents (29.7%). Intracranial lesions were found more often in the elderly. The case fatality rate was 2.0/100 hospitalized patients and was highest in the elderly.

CONCLUSIONS

The incidence of hospital-treated TBI in this study is considerably lower than that found in previous studies from Norway and Scandinavia. Despite the apparent decline in TBI hospitalization rates, our findings should also draw attention to the need for more effective preventive programmes related to falls. Studies that assess long-term consequences of TBI in elderly patients are also needed.