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Backus BE, Moustafa F, Skogen K, Sapin V, Rane N, Moya-Torrecilla F, Biberthaler P, Tenovuo O. Consensus paper on the assessment of adult patients with traumatic brain injury with Glasgow Coma Scale 13-15 at the emergency department: A multidisciplinary overview. Eur J Emerg Med 2024; 31:240-249. [PMID: 38744295 DOI: 10.1097/mej.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Traumatic brain injury (TBI) is a common reason for presenting to emergency departments (EDs). The assessment of these patients is frequently hampered by various confounders, and diagnostics is still often based on nonspecific clinical signs. Throughout Europe, there is wide variation in clinical practices, including the follow-up of those discharged from the ED. The objective is to present a practical recommendation for the assessment of adult patients with an acute TBI, focusing on milder cases not requiring in-hospital care. The aim is to advise on and harmonize practices for European settings. A multiprofessional expert panel, giving consensus recommendations based on recent scientific literature and clinical practices, is employed. The focus is on patients with a preserved consciousness (Glasgow Coma Scale 13-15) not requiring in-hospital care after ED assessment. The main results of this paper contain practical, clinically usable recommendations for acute clinical assessment, decision-making on acute head computerized tomography (CT), use of biomarkers, discharge options, and needs for follow-up, as well as a discussion of the main features and risk factors for prolonged recovery. In conclusion, this consensus paper provides a practical stepwise approach for the clinical assessment of patients with an acute TBI at the ED. Recommendations are given for the performance of acute head CT, use of brain biomarkers and disposition after ED care including careful patient information and organization of follow-up for those discharged.
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Affiliation(s)
- Barbra E Backus
- Emergency Department, Franciscus Gasthuis and Vlietland, Rotterdam
- Emergency Department, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Farès Moustafa
- Emergency Department, University Hospital Clermont Auvergne, Clermont-Ferrand, France
| | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospitals, Oslo, Norway
| | - Vincent Sapin
- Biochemistry and Molecular Genetics Department, University Hospital Clermont Auvergne, Clermont-Ferrand, France
| | - Neil Rane
- Department of Neuroradiology, St Marys Hospital Major Trauma Centre, Imperial College London NHS Trust
| | - Francisco Moya-Torrecilla
- Physical Therapy Department, School of Health Sciences, University of Malaga, Spain
- International Medical Services, Vithas Xanit International Hospital, Malaga, Spain
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar Technische Universität, Munich, Germany
| | - Olli Tenovuo
- Department of Clinical Medicine, University of Turku, Turku, Finland
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Başıbüyük GÖ, Güler ZÖ, Kılıç B, Yaylagül NK, Ay F, Bekdaş O, Özgür Ö, Gültekin T. Designing ergonomic toilets and bathrooms for older adults: A study on anthropometric dimensions and recommendations. Geriatr Nurs 2024; 55:263-269. [PMID: 38091712 DOI: 10.1016/j.gerinurse.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/06/2024]
Abstract
AIMS This study aimed to evaluate the ergonomic design of toilets and bathroom equipment for older adults using anthropometric measurements. DESIGN This was a descriptive cross-sectional study. METHODS Data were collected from 2,721 people aged ≥ 65 years in Turkey. Fourteen anthropometric measurements were evaluated. Body dimension characteristics were described using minimum, maximum, and arithmetic means and standard deviations and the 5th, 25th, 50th, 75th, and 95th percentiles. RESULTS The measurements showed that companies generally do not design bathroom toilet equipment that is suitable for older adults. CONCLUSION This study provides advice to designers and manufacturers on how to adapt their products to the bathroom according to users' body characteristics in order to increase person-environment fit for older people.
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Affiliation(s)
| | - Zümre Özdemir Güler
- Department of Economics, Söke Faculty of Management, Aydın Adnan Menderes University, Aydın, Türkiye
| | - Barış Kılıç
- Department of Gerontology, Faculty of Health Sciences, Akdeniz University, Antalya, Türkiye.
| | | | - Faruk Ay
- Department of Anthropology, Faculty of Literature, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Ozan Bekdaş
- Department of Anthropology, Faculty of Literature, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Özlem Özgür
- Department of Gerontology, Faculty of Health Sciences, Akdeniz University, Antalya, Türkiye
| | - Timur Gültekin
- Department of Anthropology, Faculty of Language, History and Geography, Ankara University, Ankara, Türkiye
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Posti JP, Luoto TM, Sipilä JOT, Rautava P, Kytö V. Changing epidemiology of traumatic brain injury among the working-aged in Finland: Admissions and neurosurgical operations. Acta Neurol Scand 2022; 146:34-41. [PMID: 35257358 DOI: 10.1111/ane.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies from Finland have highlighted an increase in the incidence of traumatic brain injuries (TBI) in older age groups and high overall mortality. We performed a comprehensive study on the changing epidemiology of TBI focusing on the acute events in the Finnish working-age population. METHODS Nationwide databases were searched for all emergency ward admissions with a TBI diagnosis for persons of 16-69 years of age during 2004-2018. RESULTS In the Finnish working-age population, there were 52,487,099 person-years, 38,810 TBI-related hospital admissions, 4664 acute neurosurgical operations (ANO), and 2247 cases of in-hospital mortality (IHM). The TBI-related hospital admission incidence was 94/100,000 person-years in men, 44/100,000 in women, and 69/100,000 overall. The incidence rate of admissions increased in women, while in men and overall, the rate decreased. The incidence rate increased in the group of 60-69 years in both genders. Lowest incidence rates were observed in the age group of 30-39 years. Occurrence risk for TBI admission was higher in men in all age groups. Trends of ANOs decreased overall, while decompressive craniectomy was the only operation type in which a rise in incidence was found. Evacuation of acute subdural hematoma was the most common ANO. Mean length of stay and IHM rate halved during the study years. CONCLUSIONS In Finland, the epidemiology of acute working-aged TBI has significantly changed. The rates of admission incidences, ANOs, and IHM nowadays represent the lower end of the range of these acute events reported in the western world.
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Affiliation(s)
- Jussi P. Posti
- Neurocenter Department of Neurosurgery and Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
| | - Teemu M. Luoto
- Department of Neurosurgery Tampere University Hospital and Tampere University Tampere Finland
| | - Jussi O. T. Sipilä
- Clinical Neurosciences University of Turku Turku Finland
- Department of Neurology Siun Sote North Karelia Central Hospital Joensuu Finland
| | - Päivi Rautava
- Clinical Research Center Turku University Hospital and University of Turku Turku Finland
| | - Ville Kytö
- Heart Centre and Center for Population Health Research Turku University Hospital and University of Turku Turku Finland
- Research Center of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland
- Administrative Center Hospital District of Southwest Finland Turku Finland
- Department of Public Health Faculty of Medicine University of Helsinki Helsinki Finland
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Nevalainen N, Luoto TM, Iverson GL, Mattila VM, Huttunen TT. Craniotomies following acute traumatic brain injury in Finland-a national study between 1997 and 2018. Acta Neurochir (Wien) 2022; 164:625-633. [PMID: 35119493 PMCID: PMC8913452 DOI: 10.1007/s00701-022-05140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
Abstract
Background A number of patients who sustain a traumatic brain injury (TBI) require surgical intervention due to acute intracranial bleeding. The aim of this retrospective study was to assess the national trends of acute craniotomies following TBI in the Finnish adult population. Methods The data were collected retrospectively from the Finnish Care Register for Health Care (1997–2018). The study cohort covered all first-time registered craniotomies following TBI in patients aged 18 years or older. A total of 7627 patients (median age = 59 years, men = 72%) were identified. Results The total annual incidence of acute trauma craniotomies decreased by 33%, from 8.6/100,000 in 1997 to 5.7/100,000 in 2018. The decrease was seen in both genders and all age groups, as well as all operation subgroups (subdural hematoma, SDH; epidural hematoma, EDH; intracerebral hematoma, ICH). The greatest incidence rate of 15.4/100,000 was found in patients 70 years or older requiring an acute trauma craniotomy. The majority of surgeries were due to an acute SDH and the patients were more often men. The difference between genders decreased with age (18–39 years = 84% men, 40–69 = 78% men, 70 + years = 55% men). The median age of the patients increased from 58 to 65 years during the 22-year study period. Conclusions The number of trauma craniotomies is gradually decreasing; nonetheless, the incidence of TBI-related craniotomies remains high among geriatric patients. Further studies are needed to determine the indications and derive evidence-based guidelines for the neurosurgical care of older adults with TBIs to meet the challenges of the growing elderly population.
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Affiliation(s)
- Nea Nevalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teemu M. Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, USA
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA USA
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
- Coxa Joint Replacement Hospital, Tampere, Finland
| | - Tuomas T. Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Cardio-Thoracic Surgery, Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland
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Kim HK, Leigh JH, Kim TW, Oh BM. Epidemiological Trends and Rehabilitation Utilization of Traumatic Brain Injury in Korea (2008-2018). BRAIN & NEUROREHABILITATION 2021; 14:e25. [PMID: 36741218 PMCID: PMC9879377 DOI: 10.12786/bn.2021.14.e25] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023] Open
Abstract
This study aimed to estimate the trend of traumatic brain injuries (TBIs) and TBI-related medical usage in Korea. Patients first diagnosed with disease codes of TBIs were included. We calculated the crude incidence and age-adjusted incidence, as well as medical cost, length of stay (LOS), clinic visits, and the number of specialized rehabilitation therapy for 1 year. Patients first diagnosed as TBI was higher in national health insurance (NH-I) than in automobile insurance (AUTO-I). In contrast with the gradual decrease of the crude incidence, total medical costs both in NH-I and AUTO-I were generally and steadily increased. For oriental medicine, total medical costs dramatically increased in both inpatient and outpatient. LOS, clinic visits, and the number of specialized rehabilitation therapy were higher in AUTO-I than in NH-I. The most frequent age groups in NH-I were the young (0-9) and old (70 or over), whereas in AUTO-I, the working age group was prominent. Our results show differences in the incidence of TBI and medical usage between NH-I and AUTO-I, which could be associated with the policy for strengthening health insurance coverage, automobile-related regulations to prevent accidents and injuries, as well as rapid changes in the structure of the population in Korea.
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Affiliation(s)
- Han-Kyoul Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Ja-ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.,Institute on Aging, Seoul National University, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Haarbauer-Krupa J, Pugh MJ, Prager EM, Harmon N, Wolfe J, Yaffe K. Epidemiology of Chronic Effects of Traumatic Brain Injury. J Neurotrauma 2021; 38:3235-3247. [PMID: 33947273 PMCID: PMC9122127 DOI: 10.1089/neu.2021.0062] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although many patients diagnosed with traumatic brain injury (TBI), particularly mild TBI, recover from their symptoms within a few weeks, a small but meaningful subset experience symptoms that persist for months or years after injury and significantly impact quality of life for the person and their family. Factors associated with an increased likelihood of negative TBI outcomes include not only characteristics of the injury and injury mechanism, but also the person’s age, pre-injury status, comorbid conditions, environment, and propensity for resilience. In this article, as part of the Brain Trauma Blueprint: TBI State of the Science framework, we examine the epidemiology of long-term outcomes of TBI, including incidence, prevalence, and risk factors. We identify the need for increased longitudinal, global, standardized, and validated assessments on incidence, recovery, and treatments, as well as standardized assessments of the influence of genetics, race, ethnicity, sex, and environment on TBI outcomes. By identifying how epidemiological factors contribute to TBI outcomes in different groups of persons and potentially impact differential disease progression, we can guide investigators and clinicians toward more-precise patient diagnosis, along with tailored management, and improve clinical trial designs, data evaluation, and patient selection criteria.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, Utah, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, San Francisco, California, USA
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KONGPRAN JIRA, THANAPOP CHAMNONG, VATTANASIT UDOMRATANA. Environmental sanitation and hygiene of elderly workers in Nakhon Si Thammarat Province, Thailand. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E152-E163. [PMID: 34322631 PMCID: PMC8283640 DOI: 10.15167/2421-4248/jpmh2021.62.1.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/26/2021] [Indexed: 11/22/2022]
Abstract
Introduction Thailand will become a completely aged society in 2021 and a super-aged society in 2030, resulting in a high proportion of older people. Living environments, especially at home, play an essential health determinant for the elders. Methods This cross-sectional analytical study evaluated 319 households in Nakhon Si Thammarat Province according to the standard of housing sanitation for elders and assessed biological contamination in food, water, and indoor air in the homes. Results The housing assessment results revealed some issues that are necessary to be improved, i.e., the wet and dry areas in bathrooms were not separated (89.4%), there was no anti-slip sheet in the bathrooms (97.2%), and handrails were not suitably installed (96.2%). The proportion of coliform bacteria contamination in the samples of cooked rice, side dish, dish, spoon, elderly hand, and drinking water was 93.3, 83.9, 82.5, 88.1, 78.0 and 97.5%, respectively. The average total bacteria count in bedrooms and kitchens was 111 CFU/m3 and 149 CFU/m3, respectively. The average total fungi count was 83 CFU/m3 in bedrooms and 93 CFU/m3 in kitchens. Most indoor air quality parameters complied with the standards. Conclusions Significant health risks for the elderly workers while living at home were injuries due to slipping fall in the house, especially in the bathroom, as well as foodborne and waterborne diseases. The health risks should be communicated to the elders. Prevention of the risks should be performed by the cooperation of relevant government agencies and the older adults in the study area.
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Affiliation(s)
- JIRA KONGPRAN
- Correspondence: Jira Kongpran, Department of Environmental Health and Technology, School of Public Health, Walailak University, Thailand - E-mail:
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