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Mulyadi M, Harianto S, Tonapa SI, Lee BO. Early Quality-of-Life Changes in Mild Traumatic Brain Injury: A Prospective Study. J Trauma Nurs 2023; 30:75-82. [PMID: 36881698 DOI: 10.1097/jtn.0000000000000706] [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: 03/09/2023]
Abstract
BACKGROUND Postinjury symptoms and decreased quality of life are common after mild traumatic brain injury. However, few studies have examined how soon, after injury, these changes dissipate. OBJECTIVES This study aimed to compare changes in postconcussion symptoms, posttraumatic stress, and illness representations and identify predictors of health-related quality of life before and 1 month after hospital discharge for mild traumatic brain injury. METHODS A prospective, multicenter, correlational design was used to measure postconcussion symptoms, posttraumatic stress, illness representations, and health-related quality of life. The survey was administered to 136 patients with mild traumatic brain injury between June 2020 and July 2021 at three hospitals in Indonesia. Data were collected at discharge and 1 month later. RESULTS Compared with before hospital discharge, data collected 1 month after discharge showed that patients experienced reduced postconcussion symptoms, posttraumatic stress, better illness perceptions, and quality of life. Those with postconcussion symptoms (β =-.35, p < .001), more posttraumatic stress symptoms (β =-.12, p = .044), more identity symptoms (β = .11, p = .008), worsened personal control (β =-.18, p = .002), worsened treatment control (β =-.16, p = .001), and negative emotional representations (β =-.17, p = .007) were significantly related to worsened health-related quality of life. CONCLUSION This study shows that within 1 month of hospital discharge, patients with mild traumatic brain injury had decreased postconcussion symptoms, posttraumatic stress, and improved illness perceptions. Efforts to impact mild brain injury quality of life should focus on inhospital care to optimize the transition to discharge.
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Affiliation(s)
- Mulyadi Mulyadi
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan (Dr Mulyadi, Mr Tonapa, and Dr Lee); School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia (Dr Mulyadi); and Faculty of Nursing (Mr Harianto) and Faculty of Vocational Studies (Mr Harianto), Airlangga University, Surabaya, Indonesia
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Gunasekaran K, Ul Islam S, Mao H. Understanding Head Injury Risks During Car-to-Pedestrian Collisions Using Realistic Vehicle and Detailed Human Body Models. STAPP CAR CRASH JOURNAL 2022; 66:175-205. [PMID: 37733825 DOI: 10.4271/2022-22-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Traumatic brain injury (TBI) is the leading cause of death and long-term disability in road traffic accidents (RTAs). Researchers have examined the effect of vehicle front shape and pedestrian body size on the risk of pedestrian head injury. On the other hand, the relationship between vehicle front shape parameters and pedestrian TBI risks involving a diverse population with varying body sizes has yet to be investigated. Thus, the purpose of this study was to comprehensively study the effect of vehicle front shape parameters and various pedestrian bodies ranging from 95th percentile male (AM95) to 6 years old (YO) child on the dynamic response of the head and the risk of TBIs during primary (vehicle) impact. At three different collision speeds (30, 40, and 50 km/h), a total of 36 car-to-pedestrian collisions (CPCs) were reconstructed using three different vehicle types (Subcompact passenger sedan, mid-sedan, and sports utility vehicle (SUV)) and four distinct THUMS pedestrian finite element (FE) models (AM50, AM95, AF05, and 6YO). We assessed skull stress and brain strains besides head linear and rotational kinematics. Our findings indicate that vehicle shape parameters especially bonnet leading edge height (BLEH), when being divided by the height of the Center of Gravity of the human body, correlated positively to head kinematics. The data from this study using realistic vehicle structures and detailed human body models showed that smaller BLEH/CG ratios reduced head injury criteria (HIC) and brain injury criteria (BrIC) values for the car center to mid-stance walking pedestrian impacts but with low-to-moderate R squared values between 0.2 to 0.5. Smaller BLEH/CG reduced head lateral bending velocities with R squared values of 0.57 to 0.63 for all impact velocities, and reduced HIC with R squared value of 0.62 for 50 km/h cases. In the future, simulations with realistic car structures and detailed human body models will be further used to simulate impacts at different locations and with various body shapes/postures.
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Affiliation(s)
- Kalish Gunasekaran
- Mechanical and Materials Engineering, Western University, London ON, Canada
| | - Sakib Ul Islam
- Mechanical and Materials Engineering, Western University, London ON, Canada
| | - Haojie Mao
- Mechanical and Materials Engineering, Western University, London ON, Canada
- School of Biomedical Engineering, Western University, London ON, Canada
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Cociu S, Cazacu-Stratu A, Chiosea L, Rojnoveanu G, Cebanu S, Peek-Asa C. A profile of traumatic brain injury within hospital emergency departments - a retrospective study in the Republic of Moldova. OPEN JOURNAL OF PREVENTIVE MEDICINE 2022; 12:175-189. [PMID: 37426428 PMCID: PMC10328057 DOI: 10.4236/ojpm.2022.129013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence, and outcome of TBI necessary. TBI is a major cause of mortality and morbidity in adolescents, young adults, and the elderly, one of the leading causes being road traffic accidents. Methods A retrospective study was conducted among patients with TBI within 2 medical institutions from Chisinau municipality: Emergency Medicine Institute (EMI) and Valentin Ignatenco Municipal Children's Hospital (MCH). A questionnaire was applied, completed on the basis of medical records according to the International Classification of Diseases (ICD) 10 codes. The collection period was August, 1 - October 31, 2018. Data were uploaded using the existing electronic data collection tool - Red Cap and analyzed through Microsoft Excel. Data collection was performed by a resident neurosurgery and a scientific researcher. The ethics committee's approval has been obtained. Results There have been identified 150 patients: 57 cases (38.5%) of TBI among children and 93 cases (61.5%) among adults aged between 18-73 years old. A large majority (62%) of head injuries were among patients from the urban area (most in adults - 60% and males - 74%). The most common mechanisms of head injury were falls (53.3%) and road traffic injuries (24%), followed by assault (14.7%) and struck by/or against (8%). The distributions by place of occurrence highlighted that most injuries occurred at home (33.4%) and transport area (25.3%). Most head injuries were registered among men 121(81.2%) with a predominance of minor Glasgow Coma Scale (GCS) (65.1%), followed by moderate GCS (9.4%), while in women all cases with GCS minor (18.8%). Conclusion The data obtained could be useful for the hospital administration in managing the necessary resources and for conducting information campaigns among the high-risk groups.
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Affiliation(s)
- Svetlana Cociu
- Department of Preventive Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Angela Cazacu-Stratu
- Department of Preventive Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Lilia Chiosea
- Valentin Ignatenco Municipal Children Hospital, Chisinau, Republic of Moldova
| | - Gheorghe Rojnoveanu
- Nicolae Anestiadi Department of Surgery no.1, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
- Emergency Medicine Institute, Chisinau, Republic of Moldova
| | - Serghei Cebanu
- Department of Preventive Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Corinne Peek-Asa
- Department of Epidemiology, School of Public Health, University of California, San Diego, USA
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Lucena LLN, Briones MVA. Effect of Cerebrolysin in severe traumatic brain injury: A multi-center, retrospective cohort study. Clin Neurol Neurosurg 2022; 216:107216. [PMID: 35344761 DOI: 10.1016/j.clineuro.2022.107216] [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: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) patients with nonoperative lesions are known to have a poorer prognosis. Recent and ongoing clinical studies have been exploring the utility of Cerebrolysin in improving patient outcomes among TBI patients; however, few studies are available on the effect of Cerebrolysin among nonoperative severe TBI patients. OBJECTIVES To determine the effects of Cerebrolysin as add-on therapy to the standard medical decompression protocol for nonoperative severe TBI patients. METHODS The study employed a retrospective cohort design and included 87 severe TBI patients on admission. In addition to the current medical decompression protocol, 42 patients received 30 ml/day Cerebrolysin for 14 days, followed by a subsequent 10 ml/day dosage for another 14 days. The control group included 45 patients who received the standard decompression protocol only. Stata MP version 16 was used for data analysis. RESULTS Compared to the control group, a significantly higher proportion of patients who received Cerebrolysin treatment achieved a favourable outcome at Day 21 post-TBI (50% vs. 87%; p < 0.00001) and GOS ≥ 4 (18% vs. 39%; p = 0.043). The mean length of hospital stay was approximately seven days shorter in the Cerebrolysin group (25.61 days vs. 31.92 days; p < 0.00001), and a significantly lower proportion of Cerebrolysin patients had a LOS ≥ 30 days (Cerebrolysin: 13%; Control: 51%; p < 0.0001). No significant group differences were seen in the 28-day mortality rate. CONCLUSION Cerebrolysin is beneficial for severe TBI patients with nonoperative lesions as evidenced by stronger improvement in GCS/GOS and shorter length of hospital stay than standard treatment alone.
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Baker CE, Martin P, Wilson MH, Ghajari M, Sharp DJ. The relationship between road traffic collision dynamics and traumatic brain injury pathology. Brain Commun 2022; 4:fcac033. [PMID: 35291690 PMCID: PMC8914876 DOI: 10.1093/braincomms/fcac033] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/15/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Claire E. Baker
- Centre for Neurotechnology, Imperial College London, South Kensington Campus, SW7 2AZ, UK
- Dyson School of Design Engineering, Imperial College London, South Kensington Campus, SW7 2AZ, UK
- Transport Research Laboratory Ltd ., Crowthorne House, Nine Mile Ride, Wokingham, Berkshire, RG40 3GA, UK
| | - Phil Martin
- Transport Research Laboratory Ltd ., Crowthorne House, Nine Mile Ride, Wokingham, Berkshire, RG40 3GA, UK
| | - Mark H. Wilson
- Imperial College London Saint Mary Campus, St Mary’s Hospital, Praed Street, London W2 1NY, UK
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College London, South Kensington Campus, SW7 2AZ, UK
| | - David J. Sharp
- Division of Brain Sciences, Imperial College London, W12 0NN, UK
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Surgical outcomes in traumatic brain injuries with bilateral mass occupying lesions. Analysis of prognostic factors. Clin Neurol Neurosurg 2020; 196:106017. [PMID: 32619900 DOI: 10.1016/j.clineuro.2020.106017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Traumatic brain injury is a silent epidemic with major impacts on national productivity as it affects the economically productive age group. Bilateral injuries are usually severe with no clearly defined predictors of outcome as per current available literature. METHODS We retrospectively assessed 102 consecutive cases of post traumatic intracranial mass lesions operated bilaterally, either simultaneously or sequentially, between January 2011 and April 2019. The primary and secondary end points of the study were to assess mortality and GCS at discharge respectively. RESULTS The cohort included 102 patients. 91(89.2 %) were males, mean age was 40(±13.6) years. Median GCS at presentation was 9 with 47(46.07 %) having moderate head injury. EDH with contusion was seen in 38(37.3 %), SDH with contusion in 24(23.5 %) and 4 patients (3.9 %) had EDH, SDH and contusion. On univariate analysis, female gender(p = 0.001), poor GCS at presentation(p < 0.001), higher Rotterdam grade on initial CT scan(p < 0.001), need for blood transfusions(p = 0.026) and intraoperative hypotension(p = 0.007) were associated with significantly higher mortality. On multivariate analysis female gender(p = 0.034), poor GCS(p = 0.026) and worse Rotterdam score(p = 0.038) were associated with mortality. Among the subgroup of survivors, GCS at presentation(p < 0.001), Rotterdam grading(p = 0.003), time to surgery after trauma(p = 0.032), duration of hospital stay(<0.001), intraoperative brain bulge(p=.003) and craniotomy instead of craniectomy(p = 0.001) were associated with clinical outcome at discharge. CONCLUSION Traumatic brain injuries with bilateral mass lesions requiring surgery have been rarely reported. In this study we have elucidated management strategies and have further studied the factors influencing mortality and clinical outcome. Careful considerations are required in decision making in such cases. Larger multicentric studies would throw more light on outcomes of this rare variety of traumatic brain injury.
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Osis SL, Diccini S. Incidence and risk factors associated with pressure injury in patients with traumatic brain injury. Int J Nurs Pract 2020; 26:e12821. [PMID: 31994827 PMCID: PMC9285356 DOI: 10.1111/ijn.12821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
AIM To identify the prevalence of pressure injury in patients diagnosed with traumatic brain injury and analyse the risk factors involved during hospitalization. METHODS This was a prospective study evaluating patients who were diagnosed with traumatic brain injury between November 2013 and September 2014. Patient characteristics, clinical and metabolic factors and therapeutic interventions, were evaluated within 30 days of hospital admission. RESULTS Most of the 240 patients included in the study were male, young, and non-Caucasian. The incidence of pressure injury was 18.8%. In terms of severity classification, the incidence of pressure injury was 2.7%, 23.2%, and 42.6% in mild, moderate, and severe traumatic brain injury, respectively. Pressure injury development was more likely in the first 10 days of hospitalization. A moderate or severe traumatic brain injury classification, the use of noradrenaline, and older age were pressure injury risk factors. The presence of pressure injury was associated with mortality within 30 days of hospitalization (P < .001). CONCLUSION The incidence of pressure injury was high in patients diagnosed with traumatic brain injury, especially in those whose injury was classified as severe. Older age, noradrenaline use, and a classification of moderate or severe traumatic brain injury were identified as pressure injury risk factors.
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Affiliation(s)
- Sibila Lilian Osis
- School of NursingState University of Amazonas, Brazilian Association Critical Care NursesManausBrazil
| | - Solange Diccini
- School of NursingFederal University of São PauloSão PauloBrazil
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Liew TYS, Ng JX, Jayne CHZ, Ragupathi T, Teo CKA, Yeo TT. Changing Demographic Profiles of Patients With Traumatic Brain Injury: An Aging Concern. Front Surg 2019; 6:37. [PMID: 31334245 PMCID: PMC6618294 DOI: 10.3389/fsurg.2019.00037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Trauma continues to be a common cause of mortality in Singapore. By understanding the epidemiology of Traumatic Brain Injury (TBI), healthcare professionals can be better equipped to tackle the increasing socioeconomic burden of disease, adopting better strategies in healthcare planning. Methodology: A retrospective review of 367 patients admitted with TBI to a tertiary medical institution from January to December 2014 was performed, studying demographic profiles, injury details and outcomes of these patients. Data was retrieved from the National Trauma Registry and the institution's database. Results: Two hundred thirty-four of the 367 patients included in this study fell into two age groups--19 to 40 years and ≥65 years. 58% of the TBI population were aged >60. Predominant mechanism of injuries in these groups were road traffic accidents and unwitnessed falls respectively. 39% of the Elderly group were on antiplatelet/anticoagulant agents (p < 0.001). While aggressive surgical intervention was more common in younger patients (p < 0.001), the elderly group had significantly longer lengths of hospital stay (p < 0.001). Though Glasgow Outcome Scale (GOS) scores at discharge were not significantly different between the two groups, elderly patients showed greater percentages of post-injury improvement subsequently. Conclusion: The demographics of TBI patients appears to have shifted toward an older population as compared to a decade ago, with an increased incidence of falls, highlighting a huge healthcare concern. We hope that this study will drive further nationwide studies in future, looking at the incidence and prevalence of TBI, and with the focus on tackling preventable causes of TBI.
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Affiliation(s)
- Terence Yi Song Liew
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Jun Xuan Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chan Hui Zhen Jayne
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tharun Ragupathi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Colin Kok Ann Teo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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Patterns, Types, and Outcomes of Head Injury in Aseer Region, Kingdom of Saudi Arabia. NEUROSCIENCE JOURNAL 2019; 2019:2782146. [PMID: 30984774 PMCID: PMC6431466 DOI: 10.1155/2019/2782146] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/30/2019] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
Background Head injuries contribute to almost 50% of all injuries. Head injuries are still one of the major causes of loss of life and loss of function among young adults. Nowadays, head injury has become a major community problem. Recently, head injury has become one of the biggest issues of almost more than 57 million people in the whole world living with the neurological problem raised by TBI, in which 10 million people require hospital base care. Objectives To determine the epidemiological aspects of patients with head injury (HI) in Aseer Central Hospital (ACH). Materials and Methods This is a retrospective cross-sectional study. Data were gathered from patients' files and the registrar's database of ACH. The study duration was January 2015–December 2017. All patients with head injury admitted to ACH during the study duration were included in the study. SPSS software was used for analysis. Descriptive statistics were obtained (mean SD frequencies, percentages). Statistical tests, t test, and chi-squared test were applied to measure the significant difference among the variables. P-value less than 0.05 was considered as a significant difference. Results There were 353 patients with head injury, and the mean ± SD of age was 27.01 ± 13.9. Motor vehicle accidents (MVA) accounted for (89.3%) of head injury. A total of 87.3% of the patients were male while 12.7% were female. Conclusion In this study, we observed that MVA is the leading cause of brain/head injuries in the KSA, despite the implementations of new speed rules. However, with new regulations of forbidding cell phone use while driving and forcing the seat belt regulations, a major impact on these numbers is expected in the future. Thus, a future study is recommended to assess these expectations.
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Nik A, Sheikh Andalibi MS, Ehsaei MR, Zarifian A, Ghayoor Karimiani E, Bahadoorkhan G. The Efficacy of Glasgow Coma Scale (GCS) Score and Acute Physiology and Chronic Health Evaluation (APACHE) II for Predicting Hospital Mortality of ICU Patients with Acute Traumatic Brain Injury. Bull Emerg Trauma 2018; 6:141-145. [PMID: 29719845 DOI: 10.29252/beat-060208] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To compare the efficacy and functional outcome of Glasgow Coma Scale (GCS) score with that of Acute Physiology and Chronic Health Evaluation Score II (APACHE II) in patients with multiple trauma admitted to the ICU. Methods This cross-sectional study included 125 patients with traumatic brain injury associated with systemic trauma admitted to the ICU of Shahid Kamyab Hospital, Mashhad, between September 2015 and December 2016. On the day of admission, data were collected from each patient to calculate GCS and APACHE II scores. Sensitivity, specificity, and correct outcome prediction was compared between GCS and APACHE II. Results Positive predictive value (PPV) at the cut-off points was higher in APACHE II (80.6%) compared with GCS (69.2%). However, negative predictive value (NPV) of GCS was slightly higher in comparison with APACHE II. Moreover, the area under the receiver operating characteristic (ROC) curve for sensitivity and specificity of GCS and APACHE II showed no significant difference (0.81±0.04 vs. 0.83±0.04; p=0.278 respectively). Conclusion Our study suggested that there was no considerable difference between GCS and APACHE II scores for predicting mortality in head injury patients. Both scales showed acceptable PPV, while APACHE II showed better results. However, the utilization of GCS in the initial assessment is recommended over APACHE II as the former provides higher time- and cost-efficiency.
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Affiliation(s)
- Amir Nik
- Student Research Committee, School of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | | | - Mohammad Reza Ehsaei
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmadreza Zarifian
- Student Research Committee, School of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | | | - Gholamreza Bahadoorkhan
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Choi YH, Lim TK, Lee SG. Clinical Features and Outcomes of Bilateral Decompression Surgery for Immediate Contralateral Hematoma after Craniectomy Following Acute Subdural Hematoma. Korean J Neurotrauma 2017; 13:108-112. [PMID: 29201843 PMCID: PMC5702744 DOI: 10.13004/kjnt.2017.13.2.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/23/2017] [Accepted: 05/09/2017] [Indexed: 11/15/2022] Open
Abstract
Objective Immediate contralateral epidural hematoma (EDH) and traumatic intracerebral hematoma (T-ICH) after craniectomy for traumatic subdural hematoma (SDH) are rare but devastating post-operative complications. Their clinical features and outcomes are not well studied. In this report, we present the clinical features and outcomes of immediate contralateral acute hematoma cases requiring a second operation. Methods This study includes 10 cases of immediate contralateral EDH and T-ICH following bilateral craniectomy for the evacuation of traumatic SDH and contralateral hematoma between 2004 and 2015. Their medical records and radiographic findings were reviewed and analyzed retrospectively. Results Ten of the 528 patients (1.89%) who underwent craniectomy for the evacuation of traumatic SDH developed post-operative EDH (n=5), T-ICH (n=5). The trauma was caused by a fall in 5 patients and by a traffic accident in 5 patients. The patients who suffered trauma due to pedestrian accidents died. Seven patients had a low admission Glasgow Coma Scale (GCS; GCS≤8) score in the preoperative state (average admission GCS, 7.7; average discharge GCS, 3.4; and average discharge Glasgow Outcome Scale, 2.0). Severe intra-operative brain swelling was noted in all patients, while skull fracture was observed in 8. Multiple associated injuries and medication for heart disease were characteristic of patients who died. Conclusion The prognosis of delayed contralateral hematoma was very poor. Multiple associated injuries, past medical history and traffic accidents, especially pedestrians were seemed to be associated with higher mortality rates. Finally, contralateral skull fractures can indicate high risk of delayed contralateral acute intracranial hematoma.
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Affiliation(s)
- Young Hwan Choi
- Department of Neurosurgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Tea Kyoo Lim
- Department of Neurosurgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Sang Gu Lee
- Department of Neurosurgery, Gachon University, Gil Medical Center, Incheon, Korea
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Pediatric emergency department visits for pedestrian and bicyclist injuries in the US. Inj Epidemiol 2017; 4:31. [PMID: 29192337 PMCID: PMC5709254 DOI: 10.1186/s40621-017-0128-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
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.
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Pinto LW, Ribeiro AP, Bahia CA, Freitas MGD. Urgent and emergency care for pedestrians injured in Brazilian traffic. CIENCIA & SAUDE COLETIVA 2016; 21:3673-3682. [PMID: 27925108 DOI: 10.1590/1413-812320152112.17722016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/22/2016] [Indexed: 11/21/2022] Open
Abstract
This paper aimed to describe the epidemiological profile of pedestrians injured in traffic accidents treated at urgent and emergency facilities participating in the 2014VIVA Survey and the characterization of these events and consequences for these victims. This is a cross-sectional study conducted in the period from September to November 2014 in 24 Brazilian state capitals and the Federal District. We analyzed variables that characterize the victim, the accident and its severity and case outcome. We calculated simple and relative frequencies and performed a bivariate analysis by gender and age group. We used the Rao-Scott test with a 5% significance level in order to verify the independence of variables. Results show that 34.3% of attendances were for individuals aged 20-39 years, 54.2% had brown skin and 35.9% of individuals had up to 4 years of schooling. Run-overs occurred mainly at night (33.6%) and in the afternoon (31.3%). Most cases resulted in discharge in all age groups, but 41.6% of the elderly (60 years and over) required hospitalization. We stress the need for public investment, prioritizing pedestrian circulation in traffic and road infrastructure planning.
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Affiliation(s)
- Liana Wernersbach Pinto
- Departamento de Estudos sobre Violência e Saúde, Fiocruz. Av. Brasil 4036/7°, Manguinhos. 21040-210 Rio de Janeiro RJ Brasil
| | - Adalgisa Peixoto Ribeiro
- Departamento de Estudos sobre Violência e Saúde, Fiocruz. Av. Brasil 4036/7°, Manguinhos. 21040-210 Rio de Janeiro RJ Brasil
| | - Camila Alves Bahia
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | - Mariana Gonçalves de Freitas
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
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Mohammadi A, Ahmadi M, Gharagozlu A. Developing a Minimum Data Set for an Information Management System to Study Traffic Accidents in Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e23677. [PMID: 27247791 PMCID: PMC4884271 DOI: 10.5812/ircmj.23677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/03/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022]
Abstract
Background: Each year, around 1.2 million people die in the road traffic incidents. Reducing traffic accidents requires an exact understanding of the risk factors associated with traffic patterns and behaviors. Properly analyzing these factors calls for a comprehensive system for collecting and processing accident data. Objectives: The aim of this study was to develop a minimum data set (MDS) for an information management system to study traffic accidents in Iran. Materials and Methods: This descriptive, cross-sectional study was performed in 2014. Data were collected from the traffic police, trauma centers, medical emergency centers, and via the internet. The investigated resources for this study were forms, databases, and documents retrieved from the internet. Forms and databases were identical, and one sample of each was evaluated. The related internet-sourced data were evaluated in their entirety. Data were collected using three checklists. In order to arrive at a consensus about the data elements, the decision Delphi technique was applied using questionnaires. The content validity and reliability of the questionnaires were assessed by experts’ opinions and the test-retest method, respectively. Results: An (MDS) of a traffic accident information management system was assigned to three sections: a minimum data set for traffic police with six classes, including 118 data elements; a trauma center with five data classes, including 57 data elements; and a medical emergency center, with 11 classes, including 64 data elements. Conclusions: Planning for the prevention of traffic accidents requires standardized data. As the foundation for crash prevention efforts, existing standard data infrastructures present policymakers and government officials with a great opportunity to strengthen and integrate existing accident information systems to better track road traffic injuries and fatalities.
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Affiliation(s)
- Ali Mohammadi
- Department of Health Information Technology, Paramedical School, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Maryam Ahmadi
- Department of Health Information Management, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Maryam Ahmadi, Department of Health Information Management, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188794302, Fax: +98-2188883334, E-mail:
| | - Alireza Gharagozlu
- Geomatics College of National Cartographic Center of Iran, Tehran, IR Iran
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Weijermars W, Bos N, Stipdonk HL. Serious road injuries in The Netherlands dissected. TRAFFIC INJURY PREVENTION 2015; 17:73-79. [PMID: 26042645 DOI: 10.1080/15389588.2015.1042577] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This article discusses the characteristics and injury patterns of serious road injuries (Maximum Abbreviated Injury Scale [MAIS] 2+ inpatients) in The Netherlands. METHODS In The Netherlands, the actual number of serious injuries is estimated by linking police data to hospital data. The distribution of serious road injuries over (1) travel mode and gender and (2) crash type and age are compared for the years 2000 and 2011. Moreover, the distribution of the injuries over the body regions is illustrated using colored injury body profiles. RESULTS The number of serious injuries is higher for men than for women and increased from 16,500 in 2000 to 19,700 in 2011. In 2011, about half (51%) of the serious road injuries were due to a bicycle crash not involving a motor vehicle. The share of casualties aged 60 years and older is relatively high (43% in 2011) in these crashes. The injury body profiles show that head injuries (31%) and injuries to the lower extremities (37%) are most prevalent. Compared to other travel modes, pedestrians and riders of powered 2-wheelers relatively often sustain lower-leg injuries compared to other travel modes. Head injuries are most prevalent in cyclists who are injured in a crash with a motorized vehicle. Cyclists who are injured in a crash not involving a motor vehicle and casualties of 60 years and older relatively often include hip or upper-leg injuries. CONCLUSION The characteristics of serious road injuries differ from those of fatalities and the distribution of injuries over the body differs by travel mode, gender, and age.
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Affiliation(s)
- Wendy Weijermars
- a SWOV Institute for Road Safety Research , The Hague , The Netherlands
| | - Niels Bos
- a SWOV Institute for Road Safety Research , The Hague , The Netherlands
| | - Henk L Stipdonk
- a SWOV Institute for Road Safety Research , The Hague , The Netherlands
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Severity, Causes and Outcomes of Traumatic Brain Injuries Occurring at Different Locations: Implications for Prevention and Public Health. Cent Eur J Public Health 2015; 23:142-8. [DOI: 10.21101/cejph.a4025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/17/2015] [Indexed: 11/15/2022]
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Guerrier G, Morisse E, Barguil Y, Gervolino S, Lhote E. Severe traumatic brain injuries from motor vehicle-related events in New Caledonia: epidemiology, outcome and public health consequences. Aust N Z J Public Health 2015; 39:188-91. [DOI: 10.1111/1753-6405.12362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/01/2014] [Accepted: 12/01/2014] [Indexed: 01/29/2023] Open
Affiliation(s)
- Gilles Guerrier
- Intensive care unit; Centre Hospitalier Territorial; New Caledonia
| | - Eloïse Morisse
- Intensive care unit; Centre Hospitalier Territorial; New Caledonia
| | - Yann Barguil
- Biochemistry Laboratory; Centre Hospitalier Territorial; New Caledonia
| | - Shirley Gervolino
- Hospital and Patient Data Section; Centre Hospitalier Territorial; New Caledonia
| | - Elisabeth Lhote
- Physiotherapy and Rehabilitation Unit; Centre Hospitalier Territorial; New Caledonia
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Ratnasingam D, Lovick DS, Weber DM, Buonocore RV, Williams WV. An unusual recovery from traumatic brain injury in a young man. LINACRE QUARTERLY 2015; 82:55-66. [PMID: 25698843 DOI: 10.1179/2050854914y.0000000030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
CONTEXT Traumatic brain injury (TBI), a complex neurological traumatic incident where brain function is disrupted due to physical trauma, can be categorized in multiple ways and is commonly scored using the Glasgow Coma Scale. Severe closed head injury is a form of TBI with a Glasgow Coma Scale less than 8. The outcomes and prognosis are not uniform in the population but mortality is estimated at 30-50 percent. In this case of severe closed head injury, the patient was able to make a near full recovery after several neurosurgery and medical treatments and intercessory prayer to Saint Luigi Guanella. FINDINGS A 21-year-old male patient received a severe closed head TBI and bilateral hemotympanum while rollerblading without a helmet. After imaging, a left frontal craniotomy and evacuation of epidural and subdural hematomas and resection of a left frontal contusion were performed. Intracranial pressure increased and the patient experienced a transtentorial herniation. He underwent a right frontotemporal and subtemporal craniectomy and evacuation of a frontotemporal subdural hematoma. The patient had intraventricular hemorrhage to which a ventriculostomy was performed and later converted to a ventriculo-peritoneal shunt for recurrent hydrocephalus. The patient was not expected to regain consciousness, but made a recovery after 24 days in the hospital and 10 days in rehabilitation. The patient followed up 6 months after injury for a cranioplasty and soon after returned to near baseline. CONCLUSIONS/CLINICAL RELEVANCE In this extraordinary case, the severe closed head injury the patient sustained required intensive neurosurgical and medical treatment and the prognosis for recovery of consciousness was very poor; however, with treatment and rehabilitation and intercessory prayer to Saint Luigi Guanella, this patient was able to recover close to baseline from a Glasgow Coma Scale of 7. LAY SUMMARY Head injuries vary in severity and traumatic brain injuries can be extremely serious leading to bleeding, loss of consciousness, and can affect verbal responses, muscles movement in motor responses, and responses with eye movement. Traumatic brain injuries require medical care to assess the severity and treat the injury. In this case report, we discuss a patient's very severe closed head injury while rollerblading without a helmet from which he was not expected to make a full recovery, but did so following intensive medical treatment, rehabilitation, and intercessory prayer to Saint Don Guanella to combat the initial injury and subsequent issues.
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Affiliation(s)
| | | | - Dennis M Weber
- Don Guanella Village, Archdiocese of Philadelphia, Philadelphia, PA, USA
| | - Richard V Buonocore
- Department of Neurosurgery, Crozer-Keystone Medical Center, Chester, PA, USA
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Bilgin S, Guclu-Gunduz A, Oruckaptan H, Kose N, Celik B. Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury. Neural Regen Res 2015; 7:1978-84. [PMID: 25624828 PMCID: PMC4298893 DOI: 10.3969/j.issn.1673-5374.2012.25.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/15/2012] [Indexed: 11/21/2022] Open
Abstract
Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.
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Affiliation(s)
- Sevil Bilgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Arzu Guclu-Gunduz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Hakan Oruckaptan
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nezire Kose
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Bülent Celik
- Department of Biostatistics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Majdan M, Rusnak M, Rehorcikova V, Brazinova A, Leitgeb J, Mauritz W. Epidemiology and patterns of transport-related fatalities in Austria 1980-2012. TRAFFIC INJURY PREVENTION 2015; 16:450-455. [PMID: 25256803 DOI: 10.1080/15389588.2014.962133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Transport-related accidents remain the largest single cause of death among people aged 15 to 29 in the European Union, and despite the decrease in number of fatalities from 1990 onwards they remain a significant public health problem. The aim of this article was to analyze the long-term trends and patterns of transport-related fatalities, identify the anatomic distribution of most significant injuries in different road users, and identify the primary populations at risk of transport-related death in Austria between 1980 and 2013. METHODS Data on transport-related fatalities based on death certificates were obtained from Statistics Austria for the analyzed period. Crude and age-standardized mortality rates per 100,000 were calculated and broken down by age, gender, and month of death, and the anatomic distribution of most significant injuries were identified. Potential years of life lost before age 75 (PYLL-75) were used as a measure of public health impact. RESULTS A total of 39,709 transport-related fatalities were identified for the studied years; 74% were males and the mean age was 42.1 years (range 0-103). A decrease in the number of fatalities (from 2018 in 1980 to 554 in 2012), mortality rates (from 26 in 1980 to 7 in 2012), and PYLL-75 (from 68,960 in 1980 to 14,931 in 2012) was observed. Introduction of major prevention milestones (compulsory use of seat belts or child restraints) may have contributed to this decrease. Men 16-24 years old were at the highest risk of transport-related death. Pedestrian victims were more likely to be women and car drivers and motorcyclists were more often men. Most fatal transport accidents occurred between the months of May and October and prevailingly in towns of fewer than 20,000 inhabitants. Injuries to the head were the most significant injuries in all user groups (>50% of cases in all road user types). Reduced mortality rates could translate into higher prevalence of long-term disabilities in survivors of transport accidents. CONCLUSIONS Despite the decreasing trend observed, transport-related fatalities remain a serious public health issue in Austria. An increase in the mortality of motor vehicle drivers warrants more preventive action in this group. Further research is needed on other outcomes of transport accidents such as long-term disabilities to elucidate the true public health burden of transport accidents.
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Affiliation(s)
- Marek Majdan
- a Department of Public Health, Faculty of Health Sciences and Social Work , Trnava University , Trnava , Slovakia
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Majdan M, Brazinova A, Wilbacher I, Rusnak M, Mauritz W. The impact of body mass index on severity, patterns and outcomes after traumatic brain injuries caused by low level falls. Eur J Trauma Emerg Surg 2015; 41:651-6. [DOI: 10.1007/s00068-014-0490-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022]
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Lopes Albuquerque CE, Nogueira Arcanjo FP, Cristino-Filho G, Mont'alverne Lopes-Filho A, Cesar de Almeida P, Prado R, Pereira-Stabile CL. How safe is your motorcycle helmet? J Oral Maxillofac Surg 2013; 72:542-9. [PMID: 24326016 DOI: 10.1016/j.joms.2013.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Motorcycle crash helmets do not totally prevent head and facial trauma. The aim of this study was to investigate if protection offered by helmets differs according to helmet type. MATERIALS AND METHODS In this retrospective cohort study, outpatient records of motorcyclists were analyzed for the Facial Injury Severity Scale (FISS), traumatic brain injury (TBI), facial fractures, and helmet use. Statistical analysis was conducted using the Fisher and Bonferroni tests, bivariate regression analysis, and 1-way analysis of variance. RESULTS There were 253 motorcyclists who sustained craniomaxillofacial injuries and were referred for outpatient treatment (men, 88.9%; mean age, 29.64 ± 11.6 yr); 60.1% had up to 9 years of formal education; 156 patients reported not using crash helmets, 51 were using open-face helmets, and 46 were using full-face helmets. The mean FISS score was significantly higher for unhelmeted riders compared with full-face helmet riders (P = .047), with no difference between unhelmeted riders and open-face helmet users (P = 1.00). Results for TBI were statistically greater for those wearing open-face helmets compared with full-face helmets (P = .035). CONCLUSION In this study, a large percentage of motorcyclists had facial fractures and TBI, and crash helmets did not always offer adequate protection against craniomaxillofacial injury, especially open-face helmets. Thus, further investigation into helmet types and quality of protection offered is recommended.
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Affiliation(s)
- Carlos Eduardo Lopes Albuquerque
- Oral and Maxillofacial Surgeon, Department of Craniomaxillofacial Surgery, Santa Casa de Misericórdia de Sobral Hospital, Sobral, Brazil.
| | | | - Gerardo Cristino-Filho
- Neurologist-in-Chief, Department of Neurology, Santa Casa de Misericórdia de Sobral Hospital, Sobral, Brazil
| | - Antônio Mont'alverne Lopes-Filho
- Oral and Maxillofacial Surgeon, Department of Craniomaxillofacial Surgery, Santa Casa de Misericórdia de Sobral Hospital, Sobral, Brazil
| | | | - Roberto Prado
- Professor, Department of Dental Medicine, Universidade do Grande Rio, Brazil
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Andruszkow H, Urner J, Deniz E, Probst C, Grün O, Lohse R, Frink M, Hildebrand F, Zeckey C. Subjective impact of traumatic brain injury on long-term outcome at a minimum of 10 years after trauma- first results of a survey on 368 patients from a single academic trauma center in Germany. Patient Saf Surg 2013; 7:32. [PMID: 24112807 PMCID: PMC3853225 DOI: 10.1186/1754-9493-7-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/07/2013] [Indexed: 11/22/2022] Open
Abstract
Background Traumatic Brain Injury (TBI) may lead to significant impairments in personal, social and professional life. However, knowledge of the influence on long-term outcome after TBI is sparse. We therefore aimed to investigate the subjective effects of TBI on long-term outcome at a minimum of 10 years after trauma in one of the largest study populations in Germany. Methods The current investigation represents a retrospective cohort study at a level I trauma center including physical examination or standardized questionnaires of patients with mild, moderate or severe isolated TBI with a minimum follow-up of 10 years. We investigated the subjective physical, psychological and social outcome evaluating the Glasgow Outcome Scale, short-form 12, and social as well as vocational living circumstances. Results 368 patients aged 0 to 88 years were included. Patients with severe TBI were younger compared to patients with moderate or mild TBI (p < 0.05). Patients with severe TBI lived more often as single after the trauma impact. A significantly worse outcome was associated with higher severity of TBI resulting in an increased incidence of mental disability. A professional decline was analyzed in case of severe TBI resulting in significant loss of salary. Conclusions The severity of TBI significantly influenced the subjective social and living conditions. Subjective mental and physical outcome as well as professional life depended on the severity of TBI 10 years after the injury.
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Affiliation(s)
- Hagen Andruszkow
- Department for Trauma and Reconstructive Surgery, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074 Germany.
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Nyholm L, Howells T, Enblad P, Lewén A. Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome. Ups J Med Sci 2013; 118:169-80. [PMID: 23837596 PMCID: PMC3713382 DOI: 10.3109/03009734.2013.806616] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To improve neurointensive care (NIC) and outcome for traumatic brain injury (TBI) patients it is crucial to define and monitor indexes of the quality of patient care. With this purpose we established the web-based Uppsala TBI register in 2008. In this study we will describe and analyze the data collected during the first three years of this project. METHODS Data from the medical charts were organized in three columns containing: 1) Admission data; 2) Data from the NIC period including neurosurgery, type of monitoring, treatment, complications, neurological condition at discharge, and the amount of secondary insults; 3) Outcome six months after injury. Indexes of the quality of care implemented include: 1) Index of improvement; 2) Index of change; 3) The percentages of 'Talk and die' and 'Talk and deteriorate' patients. RESULTS Altogether 314 patients were included 2008-2010: 66 women and 248 men aged 0-86 years. Automatic reports showed that the proportion of patients improving during NIC varied between 80% and 60%. The percentage of deteriorated patients was less than 10%. The percentage of Talk and die/Talk and deteriorate cases was <1%. The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay. The occurrences of secondary insults were less than 5% of good monitoring time for intracranial pressure (ICP) >25 mmHg, cerebral perfusion pressure (CPP) <50 mmHg, and systolic blood pressure <100 mmHg. Favorable outcome was achieved by 64% of adults. CONCLUSION The Uppsala TBI register enables the routine monitoring of NIC quality indexes.
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Affiliation(s)
- Lena Nyholm
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Tim Howells
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Anders Lewén
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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