High-Risk Periods for Adult Traumatic Brain Injuries: A Nationwide Population-Based Study

GPT-agents based on medical guidelines can improve the responsiveness and explainability of outcomes for traumatic brain injury rehabilitation

This study explored the application of generative pre-trained transformer (GPT) agents based on medical guidelines using large language model (LLM) technology for traumatic brain injury (TBI) rehabilitation-related questions. To assess the effectiveness of multiple agents (GPT-agents) created using GPT-4, a comparison was conducted using direct GPT-4 as the control group (GPT-4). The GPT-agents comprised multiple agents with distinct functions, including "Medical Guideline Classification", "Question Retrieval", "Matching Evaluation", "Intelligent Question Answering (QA)", and "Results Evaluation and Source Citation". Brain rehabilitation questions were selected from the doctor-patient Q&A database for assessment. The primary endpoint was a better answer. The secondary endpoints were accuracy, completeness, explainability, and empathy. Thirty questions were answered; overall GPT-agents took substantially longer and more words to respond than GPT-4 (time: 54.05 vs. 9.66 s, words: 371 vs. 57). However, GPT-agents provided superior answers in more cases compared to GPT-4 (66.7 vs. 33.3%). GPT-Agents surpassed GPT-4 in accuracy evaluation (3.8 ± 1.02 vs. 3.2 ± 0.96, p = 0.0234). No difference in incomplete answers was found (2 ± 0.87 vs. 1.7 ± 0.79, p = 0.213). However, in terms of explainability (2.79 ± 0.45 vs. 07 ± 0.52, p < 0.001) and empathy (2.63 ± 0.57 vs. 1.08 ± 0.51, p < 0.001) evaluation, the GPT-agents performed notably better. Based on medical guidelines, GPT-agents enhanced the accuracy and empathy of responses to TBI rehabilitation questions. This study provides guideline references and demonstrates improved clinical explainability. However, further validation through multicenter trials in a clinical setting is necessary. This study offers practical insights and establishes groundwork for the potential theoretical integration of LLM-agents medicine.

Weekend Admission and Mortality in Patients With Traumatic Brain Injury: A Meta-analysis

Objective

Previous studies have reported the presence of a "weekend effect" with respect to mortality in serious emergency admissions, including cases of traumatic brain injury (TBI). However, the relationship between weekend hospitalization and TBI mortality has not been fully established. This study aimed to conduct a systematic review of available evidence and investigate differences in mortality among TBI patients between weekday and weekend admissions.

Methods

Electronic databases including PubMed, Cochrane Library, and Embase were used to obtain relevant articles. Mortality, as the primary outcome of interest, encompassed in-hospital or 30-day mortality. Mortality rates were compared between the 2 groups, weekend and weekday admissions. Additionally, meta-regression analysis was performed on potential confounders to verify and provide comparative results.

Results

A total of 7 studies involving 522,942 TBI patients were eligible for inclusion in the synthesis of the systematic review. Of these patients, 71.6% were admitted during weekdays, whereas 28.4% were hospitalized on weekends. The overall integrated mortality was 11.0% (57,286/522,942), with a mortality rate of 10.8% in the weekday group and 11.3% in the weekend group. Pooled analysis revealed no significant difference in mortality between the weekday and weekend groups (risk ratio, 0.99; 95% confidence interval, 0.90-1.09; p=0.78). Furthermore, the meta-regression analysis for sensitivity assessment showed no modifying effect on mortality (p=0.79).

Conclusion

This study found no difference in mortality rates between weekday and weekend admissions among TBI patients. Additional sensitivity analyses also demonstrated no significant increase in the risk of mortality in the weekend group.

Is there a weekend effect on mortality rate and outcome for moderate and severe traumatic brain injury? A population-based, observational cohort study

Purpose

The aim of the study was to analyse patient and injury characteristics and the effects of weekend admissions on mortality rate and outcome after moderate and severe traumatic brain injuries.

Methods

This is an observational cohort study based on data from a prospectively maintained regional trauma registry in South Western Norway. Patients with moderate and severe traumatic brain injury admitted between January 1st, 2004 and December 31st, 2019 were included in this study.

Results

During the study period 688 patients were included in the study with similar distribution between moderate (n ​= ​318) and severe (n ​= ​370) traumatic brain injury. Mortality rate was 46% in severe and 13% in moderate traumatic brain injury. Two hundred and thirty-one (34%) patients were admitted during weekends. Patients admitted during weekends were significantly younger (median age (IQR) 32.0 (25.5-67.0) vs 47.0 (20.0-55.0), p ​< ​0.001). Pre-injury ASA 1 was significantly more common in patients admitted during weekends (n ​= ​146, 64%, p ​= ​0.001) while ASA 3 showed significance during weekdays compared to weekends (n ​= ​101, 22%, p ​= ​0.013). On binominal logistic regression analysis mortality rate was significantly higher with older age (OR 1.03, 95% CI for OR 1.02-1.04, p ​< ​0.001) and increasing TBI severity (OR 7.08, 95% CI for OR 4.67-10.73, p ​< ​0.001).

Conclusions

Mortality rate and poor clinical outcome remain high in severe traumatic brain injury. While a higher number of patients are admitted during the weekend, mortality rate does not differ from weekday admissions.

Changing epidemiology of traumatic brain injury among the working-aged in Finland: Admissions and neurosurgical operations

BACKGROUND

Recent studies from Finland have highlighted an increase in the incidence of traumatic brain injuries (TBI) in older age groups and high overall mortality. We performed a comprehensive study on the changing epidemiology of TBI focusing on the acute events in the Finnish working-age population.

METHODS

Nationwide databases were searched for all emergency ward admissions with a TBI diagnosis for persons of 16-69 years of age during 2004-2018.

RESULTS

In the Finnish working-age population, there were 52,487,099 person-years, 38,810 TBI-related hospital admissions, 4664 acute neurosurgical operations (ANO), and 2247 cases of in-hospital mortality (IHM). The TBI-related hospital admission incidence was 94/100,000 person-years in men, 44/100,000 in women, and 69/100,000 overall. The incidence rate of admissions increased in women, while in men and overall, the rate decreased. The incidence rate increased in the group of 60-69 years in both genders. Lowest incidence rates were observed in the age group of 30-39 years. Occurrence risk for TBI admission was higher in men in all age groups. Trends of ANOs decreased overall, while decompressive craniectomy was the only operation type in which a rise in incidence was found. Evacuation of acute subdural hematoma was the most common ANO. Mean length of stay and IHM rate halved during the study years.

CONCLUSIONS

In Finland, the epidemiology of acute working-aged TBI has significantly changed. The rates of admission incidences, ANOs, and IHM nowadays represent the lower end of the range of these acute events reported in the western world.