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Brazinova A, Rehorcikova V, Taylor MS, Buckova V, Majdan M, Psota M, Peeters W, Feigin V, Theadom A, Holkovic L, Synnot A. Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review. J Neurotrauma 2021; 38:1411-1440. [PMID: 26537996 PMCID: PMC8082737 DOI: 10.1089/neu.2015.4126] [Citation(s) in RCA: 243] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
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.
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Affiliation(s)
- Alexandra Brazinova
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Veronika Rehorcikova
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Mark S Taylor
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Veronika Buckova
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Marek Majdan
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Marek Psota
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Wouter Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- National Institute for Stroke and Applied Neuroscience, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lubomir Holkovic
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Anneliese Synnot
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. J Neurosurg 2019; 130:1080-1097. [PMID: 29701556 DOI: 10.3171/2017.10.jns17352] [Citation(s) in RCA: 1142] [Impact Index Per Article: 228.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/18/2017] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 2Department of Neurological Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center
| | - Abbas Rattani
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 3Meharry Medical College, School of Medicine, Nashville, Tennessee
| | | | - Ronnie E Baticulon
- 5University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Ya-Ching Hung
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
| | - Maria Punchak
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 6David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amit Agrawal
- 7Department of Neurosurgery, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Amos O Adeleye
- 8Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan
- 9Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Mark G Shrime
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 10Office of Global Surgery and Health, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Andrés M Rubiano
- 11Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia
| | - Jeffrey V Rosenfeld
- 12Department of Neurosurgery, Alfred Hospital
- 13Department of Surgery, Monash University, Melbourne, Australia; and
- 14Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kee B Park
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
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Babl FE, Pfeiffer H, Dalziel SR, Oakley E, Anderson V, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Hearps SJC, Crowe L. Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study. Emerg Med Australas 2018; 31:546-554. [DOI: 10.1111/1742-6723.13202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Franz E Babl
- Emergency DepartmentRoyal Children's Hospital Melbourne Victoria Australia
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of Melbourne Melbourne Victoria Australia
| | - Helena Pfeiffer
- Emergency DepartmentRoyal Children's Hospital Melbourne Victoria Australia
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
| | - Stuart R Dalziel
- Emergency DepartmentStarship Children's Health Auckland New Zealand
- Liggins InstituteThe University of Auckland Auckland New Zealand
| | - Ed Oakley
- Emergency DepartmentRoyal Children's Hospital Melbourne Victoria Australia
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of Melbourne Melbourne Victoria Australia
| | - Vicki Anderson
- Emergency DepartmentRoyal Children's Hospital Melbourne Victoria Australia
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of Melbourne Melbourne Victoria Australia
| | - Meredith L Borland
- Emergency DepartmentPrincess Margaret Hospital for Children Perth Western Australia Australia
- Divisions of Paediatrics and Emergency Medicine, School of MedicineThe University of Western Australia Perth Western Australia Australia
| | - Natalie Phillips
- Lady Cilento Children's Hospital, Brisbane and Child Health Research Centre, School of MedicineThe University of Queensland Brisbane Queensland Australia
| | - Amit Kochar
- Emergency DepartmentWomen's and Children's Hospital Adelaide South Australia Australia
| | - Sarah Dalton
- Emergency DepartmentThe Children's Hospital at Westmead Sydney New South Wales Australia
| | - John A Cheek
- Emergency DepartmentRoyal Children's Hospital Melbourne Victoria Australia
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
- Emergency DepartmentMonash Medical Centre Melbourne Victoria Australia
| | - Yuri Gilhotra
- Lady Cilento Children's Hospital, Brisbane and Child Health Research Centre, School of MedicineThe University of Queensland Brisbane Queensland Australia
| | - Jeremy Furyk
- Emergency DepartmentThe Townsville Hospital Townsville Queensland Australia
| | - Jocelyn Neutze
- Emergency DepartmentKidzfirst Middlemore Hospital Auckland New Zealand
| | - Mark D Lyttle
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
- Emergency DepartmentBristol Royal Hospital for Children Bristol UK
- Academic Department of Emergency CareUniversity of the West of England Bristol UK
| | - Silvia Bressan
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of Women's and Children's HealthUniversity of Padova Padova Italy
| | - Susan Donath
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of Melbourne Melbourne Victoria Australia
| | - Stephen JC Hearps
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
| | - Louise Crowe
- Emergency Research GroupMurdoch Children's Research Institute Melbourne Victoria Australia
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Durand E, Watier L, Fix M, Weiss JJ, Chevignard M, Pradat-Diehl P. Prevalence of traumatic brain injury and epilepsy among prisoners in France: Results of the Fleury TBI study. Brain Inj 2016; 30:363-372. [PMID: 26963289 DOI: 10.3109/02699052.2015.1131848] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- E Durand
- a Sorbonne Universités , UPMC, Laboratoire d'Imagerie Biomédicale (LIB) , Paris , France.,b Fondation Sainte Marie, Service de MPR , Paris , France
| | - L Watier
- c Inserm , Paris , France.,d Institut Pasteur, PhEMI , Paris , France.,e Université Versailles Saint Quentin , Faculté de Médecine de Paris et Ile -de -France Ouest , France
| | - M Fix
- f UCSA des maisons d'arrêt de Fleury-Mérogis , Sainte Geneviève des Bois , France
| | - J J Weiss
- g Centre Ressources francilien du traumatisme crânien , Paris , France
| | - M Chevignard
- a Sorbonne Universités , UPMC, Laboratoire d'Imagerie Biomédicale (LIB) , Paris , France.,h Service de Rééducation des pathologies neurologiques acquises de l'enfant , Hôpitaux de Saint Maurice , Saint Maurice , France
| | - P Pradat-Diehl
- a Sorbonne Universités , UPMC, Laboratoire d'Imagerie Biomédicale (LIB) , Paris , France.,i Service de Médecine physique et de réadaptation , Hôpital de la Pitié-Salpêtrière , Paris , France
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Lloyd J, Wilson ML, Tenovuo O, Saarijärvi S. Outcomes from mild and moderate traumatic brain injuries among children and adolescents: A systematic review of studies from 2008–2013. Brain Inj 2015; 29:539-49. [DOI: 10.3109/02699052.2014.1002003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Kloet AJ, Hilberink SR, Roebroeck ME, Catsman-Berrevoets CE, Peeters E, Lambregts SAM, van Markus-Doornbosch F, Vliet Vlieland TPM. Youth with acquired brain injury in The Netherlands: A multi-centre study. Brain Inj 2013; 27:843-9. [DOI: 10.3109/02699052.2013.775496] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Crowe LM, Catroppa C, Anderson V, Babl FE. Head injuries in children under 3 years. Injury 2012; 43:2141-5. [PMID: 22921385 DOI: 10.1016/j.injury.2012.07.195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 07/24/2012] [Accepted: 07/27/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND A significant number of children under 3 years sustain a head injury every year. Despite this few studies have provided detailed information about these injuries. METHODS A retrospective review of the medical files all children aged 0-3 years who attended a paediatric emergency department for treatment over a 2-year period. RESULTS Children aged 0-6 months had the highest rate of moderate head injury. Children under 12 months were at the greatest risk of injury. Falls were the most common cause of injury including falls from caregiver's arms. CONCLUSIONS Children under 12 months are at significant risk of head injury, many of these injuries could be prevented by increased parental supervision or improved home safety.
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Affiliation(s)
- Louise M Crowe
- Psychological Science, University of Melbourne, Melbourne, Australia.
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Andersson EE, Sejdhage R, Wage V. Mild traumatic brain injuries in children between 0-16 years of age: a survey of activities and places when an accident occurs. Dev Neurorehabil 2012; 15:26-30. [PMID: 22256831 DOI: 10.3109/17518423.2011.633570] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to identify what activities cause most mild traumatic brain injury (MTBI) among boys and girls between 0-16 years of age. METHODS Based on a randomized controlled study, a retrospective analysis was conducted among 765 children. RESULT The most common causes of injury were falls from a height and falls from the same level. The most common place where the accident occurred was at 'home' followed by 'pre-school/school'. The highest incidence was 'play' followed by 'hit by another person', thereafter 'baby nursing'. Boys are more often injured than girls, but with no difference between boys and girls in terms of which activities that cause MTBI. CONCLUSION Supervision during play at home as well as better designed schoolyards and playgrounds are required to prevent accidents. Furthermore, well-documented medical records are necessary to identify activities causing MTBI among children.
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10
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Abstract
PURPOSE Traumatic brain injury (TBI) is an important cause of morbidity and mortality in children. Despite the high incidence of head injury among children, the mortality rate is low. There is a lack of studies that describe children's age-specific symptoms in relation to outcome. The purpose is to investigate if other described symptoms could be used as a predictor of intracranial injury in children. METHODS Retrospective review of data from all children who during 1 year were admitted due to a brain injury. RESULTS During 1 year 724 children visited the ED due to a brain injury. A significant difference was found between age groups and other documented initial symptoms, but no single symptoms could be used as a predictor for intracranial injury. CONCLUSION Unconsciousness as a predictor for brain injury should be used with caution in children. Significant differences were found in other documented symptoms between age groups.
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Affiliation(s)
- Ann-Charlotte Falk
- Karolinska Institut, Woman and Child Health, Astrid Lindgren Childrens Hospital, Neuropediatric Research Unit, Stockholm, Sweden
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Ginstfeldt T, Emanuelson I. An overview of attention deficits after paediatric traumatic brain injury. Brain Inj 2010; 24:1123-34. [DOI: 10.3109/02699052.2010.506853] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chevignard M, Toure H, Brugel DG, Poirier J, Laurent-Vannier A. A comprehensive model of care for rehabilitation of children with acquired brain injuries. Child Care Health Dev 2010; 36:31-43. [PMID: 19438875 DOI: 10.1111/j.1365-2214.2009.00949.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acquired brain injury (ABI) is a leading cause of death and lifelong acquired disability in children and remains a significant public health issue. Deficits may only become fully apparent when developmental demands increase and once cognitive processes are expected to be fully developed. It is therefore necessary to provide organized long-term follow-up for children post ABI. Despite these recommendations, it has been shown that only a small proportion of children received specialized rehabilitation and adequate follow-up after ABI. AIMS The aims are: (i) to describe a comprehensive model of care devoted to children with acquired brain injuries; and (ii) to provide descriptive data analysing the characteristics of children followed up, the type/amount of services provided and general outcomes. PROGRAMME DESCRIPTION The programme features an in- and outpatient rehabilitation facility, where multidisciplinary rehabilitation and specialized schooling are provided. The ultimate goal of the programme is to promote each child's successful reintegration in school and in the community. Adequate preparation of discharge is essential, long-term follow-up is organized, and an outreach programme has been developed to deal with the complex delayed psychosocial issues. RESULTS Overall outcome, as measured by the Glasgow Outcome Scale, improved dramatically between admission (3.3; SD = 0.45) and discharge (2.15; SD = 0.74). Most of the children were discharged home with an adequate personalized plan for ongoing rehabilitation and school adaptations. Analysis of the outreach programme underlines the more challenging issues arising in late adolescence-early adulthood. CONCLUSION Given the specificities of childhood ABI, long-term specific care must be organized and co-ordinated, regardless of injury severity.
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Affiliation(s)
- M Chevignard
- Physical Medicine and Rehabilitation Department for children with acquired neurological injuries, Hôpital National de Saint Maurice, 14, rue du Val d'Osne, 94415 Saint Maurice, France.
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Tingberg B, Ygge BM. Response to Corlett J & Taylor J (2009) Commentary on Tingberg B, Bredlöv B & Ygge B-M (2008) Nurses' experience in clinical encounters with children experiencing abuse and their parents. Journal of Clinical Nursing 17, 2718-2724 in Journal of Clinical Nursing 18, 3202-3204. J Clin Nurs 2009; 18:3205-6. [PMID: 19825118 DOI: 10.1111/j.1365-2702.2009.02923.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Björn Tingberg
- Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
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Outcomes in Pediatric Trauma Care in the Stockholm Region. Eur J Trauma Emerg Surg 2009; 36:308-17. [PMID: 26816035 DOI: 10.1007/s00068-009-9080-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although trauma is a leading cause of pediatric mortality and morbidity in Sweden, few studies have examined the outcome of pediatric trauma. OBJECTIVE Here, we describe the age and gender distribution, injury mechanisms, injury severity, and outcome of pediatric trauma in the Stockholm region. METHODS This retrospective study comprises all trauma patients (age ≤ 15 years) admitted to a regional pediatric trauma center and all pediatric deaths due to trauma in Stockholm in 2002. Data from the trauma registry database were verified by comparison with medical records and autopsy reports. Outcome was measured by mortality and length of stay in a pediatric intensive care unit (PICU) and acute care hospital. RESULTS In all, 432 injured children were included. The median age was 10 years and 59% were males. The median injury severity score was 4 (interquartile range [IQR] 1-9) and 50% sustained head injuries. Mortality was low (1%) and the median length of hospital stay was 2 days (IQR 1-3); 19% stayed in a PICU and, of those, 89% stayed for one day. Comparison with medical records showed that much information in the trauma registry database was either incorrect or missing. CONCLUSIONS Many injuries were minor and half of the children were discharged home from the emergency department.Head injurieswere themost common injury in all age groups. The most severe head injuries were seen in the youngest group and were caused by falls. Trauma team activation criteria should be improved to avoid overutilization. The quality and completeness of data in the trauma registry must be enhanced.
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Falk AC, Von Wendt L, Söderkvist BK. The specificity of post-concussive symptoms in the pediatric population. J Child Health Care 2009; 13:227-38. [PMID: 19713406 DOI: 10.1177/1367493509336691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study compared patterns of reported symptoms between a mild head injury group and a group of children with abdominal complaints visiting an emergency department. Children (0-15 years) admitted to an emergency department during a three-month period with a history of head injury and a comparison group of children were included. Medical records at the time of injury were reviewed and follow-up questionnaires focused on presumed symptoms related to concussion at three months post-visit. The comparison group reported significantly more change in behaviour than the head injury group. However, for the older children, higher intensity of symptoms was reported by the comparison group compared to the head injury group. Initial differences in the amount and presence of symptoms between the two groups did not reflect the findings at three months; both groups reported symptoms or changes at three months after the event. Evaluating children aged under five, their symptoms and recovery patterns after a head injury is recommended.
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Affiliation(s)
- Ann-Charlotte Falk
- Department of Woman and Child Health, Neuropediatric Research Unit, Karolinska Institutet, Stockholm, Sweden.
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Zakhary MM, Wesolowski JR, Sewick AE, Carlson M, Mehrotha N, Maly P, Sundgren PC. Prevalence and etiology of intracranial hemorrhage in term children under the age of two years: a retrospective study of computerized tomographic imaging and clinical outcome in 798 children. Acad Radiol 2009; 16:572-7. [PMID: 19345898 DOI: 10.1016/j.acra.2009.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 10/31/2008] [Accepted: 01/06/2009] [Indexed: 01/21/2023]
Abstract
RATIONALE AND OBJECTIVES The purposes of this study were to retrospectively identify various etiologies underlying intracranial hemorrhages (ICHs) in term infants aged <2 years and their respective prevalence in this population and to describe the long-term clinical outcomes in these patients. MATERIALS AND METHODS A retrospective review of the medical records and computed tomographic studies of the head in 798 term infants aged 0 to 24 months with suspected or known ICHs was conducted. RESULTS ICHs were present in 195 of the 798 infants (24%). More than one type of ICH was present in 32%. Subdural hemorrhage was the most frequent type of ICH, occurring in 63% of the infants. Good clinical outcomes were present in 49% of the infants but varied depending on the location, etiology, and timing of the ICH. CONCLUSION The incidence of various etiologies of ICH depended on the ages of the infants. The overall clinical outcomes were good, with no long-term sequelae in half of the infants presenting with ICHs. In infants aged >4 weeks presenting with ICHs, special attention should be given to the possibility of nonaccidental trauma etiology, because this is common and has worse long-term outcomes.
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Tingberg B, Falk AC, Flodmark O, Ygge BM. Evaluation of documentation in potential abusive head injury of infants in a Paediatric Emergency Department. Acta Paediatr 2009; 98:777-81. [PMID: 19389121 DOI: 10.1111/j.1651-2227.2009.01241.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim is to evaluate medical record documentation regarding potential abusive head injury (AHI) in infants presenting to a Paediatric Emergency Department (ED) with certain primary complaints known to be associated with AHI. METHODS A database search was performed to find all medical records over a period of one year relating to those children who had one AHI-related primary complaint and who had had a CT head-scan performed in conjunction with admission. Each medical record was reviewed, in order to assess whether potential abuse had been investigated and documented. Each CT-scan image was re-evaluated for missed indications of potential injuries attributable to AHI. RESULTS Forty-seven such medical records were found. Of these, 87% showed the diagnosis to be head injuries. The largest group of children was in the age group 0-3 months (38%). Of the children admitted to the Paediatric ED due to a head injury, 54% had a history deemed to raise suspicions of abuse but only five of them had had a documented investigation of child abuse. The re-evaluation of the CT-scans showed no missed cases. CONCLUSION In this study we found that among children with known risk factors for AHI, only a few had documentation regarding potential child abuse. The use of a standardized protocol could be helpful in the important work to help staff discover potential AHI.
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Affiliation(s)
- Björn Tingberg
- Astrid Lindgren Children's Hospital, Karolinska Institutet, Department of Woman and Child Health, Stockholm, Sweden.
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Falk AC, von Wendt L, Söderkvist BK. Families’ perceptions of given information in relation to their child’s head injury. Scand J Caring Sci 2009; 23:125-9. [DOI: 10.1111/j.1471-6712.2008.00598.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Falk AC, von Wendt L, Klang B. Informational needs in families after their child's mild head injury. PATIENT EDUCATION AND COUNSELING 2008; 70:251-255. [PMID: 18037600 DOI: 10.1016/j.pec.2007.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 09/26/2007] [Accepted: 10/04/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE When a child is hospitalized due to an illness or injury, the entire family may experience stress and/or anxiety. According to parents who have been in such a situation, providing adequate information is one of the most valuable ways to help the family deal with such feelings. Most mild head injuries suffered by children do not require hospitalisation and in such cases, their families should be provided with appropriate information in connection with their visit to the emergency ward. In the present study, family informational needs are characterized. METHODS The families of 57 children who had suffered a mild head injury at 0-15 years of age answered one open-ended question. The analysis was carried out using content analysis. RESULTS This analysis revealed two types of needs, i.e., a need for information concerning the head injury itself and how to provide care, as well as a need for reassurance and support in sharing and coping with the emotional burden. CONCLUSION Despite differences in the severity of the child's head injury and requirement for hospitalisation, all the families expressed the same informational needs but also the need for emotional support. PRACTICE IMPLICATIONS In connection with the treatment of children with head injuries, health-care personnel should provide the parents both with information concerning the injury and its treatment and with emotional support.
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Affiliation(s)
- Ann-Charlotte Falk
- Department of Woman and Child Health, Neuropediatric Research Unit, Karolinska Institute, Astrid Lindgren Children's Hospital, Q2:07, SE-171 76 Stockholm, Sweden.
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