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Traumatic brain injury incidence and mortality rates (crude) per 100,000 population per year in country-level studies.
Source publication
Objective:
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.
Methods:
PubMed, Cinahl, Embase and Web of Science were searched in January 2015 for observational,...
Contexts in source publication
Context 1
... the group of country-level studies, the range of reported crude incidence rates is as follows: the lowest reported incidence rate is by Pérez and colleagues (2012) in Spain (study period 2000-2009; 47.3 per 100,000 population per year) 27 ; the highest is reported by Servadei and colleagues (1985) for the Republic of San Marino (study period 1981-1982; 694 per 100,000 population per year). 28 Crude incidence and mortality rates of all country-level studies that include all ages and all severities of injury are presented in Figure 2 in chronological order by study period. ...
Context 2
... dence rates for all ages and all severities. Two studies reported on only one mechanism of injury-traffic accidents. Figure 3 shows the crude incidence and mortality rates of these studies that include all ages and all TBI severity in chronological order by study period. The range is even larger here than in the group of country-level studies (Fig. 2): the lowest is reported by Andelic and colleagues (2008) for Norway (83.3 per 100,000 population per year) 29 ; and the largest is reported by Servadei and colleagues (1988) for Italy (849 per 100,000 population per year). 30 The range of crude incidence rates with confidence intervals in two sets of studies -nine country-level studies ...
Context 3
... the 27 studies reporting mortality rates, 14 reported mortality across ages and severities (Tables 6 and 7). Mortality rates of studies including all ages and all severities are presented together, with in- cidence rates in Figure 2 for country-level studies, and Figure 3 for regional-level area studies. As with incidence, range of reported crude mortality rates is quite large-from 9 per 100,000 population per year (Steudel and colleagues [2005]) 37 to 28.10 per 100,000 population per year (Mauritz and colleagues [2014]) 38 in country- level studies, and from 3.3 per 100,000 population per year (Rickels and colleagues [2010]) 39 to 24.4 per 100,000 population per year (Servadei and colleagues [1988]) 36 in regional-level studies. ...
Context 4
... no formal test or meta-analysis has been carried out, it is possible to observe an apparent slight downwards trend in incidence of TBI over time, in both country-level ( Fig. 2) and regional-level graphs (Fig. 3). However, if the highest outliers on each graph are ignored (Servadei and colleagues [1985] 28 and Servadei and colleagues [1988], 30 respectively), the reduction over time is much less apparent. There is little or no indication of a change over time in the mortality rates at either country-or ...
Citations
... The baseline patient characteristics reported in this study are in concordance with previous studies in terms of the Table 2 Baseline characteristics and type of intracranial lesions in patients with TBI with confirmed intracranial lesions stratified by primary referral to a regional or specialised centre, N = 1,180 Table 3 Crude mortality rates and risk ratios of patients with TBI with confirmed intracranial lesions by primary referral to a regional or specialised centre, N = 1,180 demographics of a median age in the range 40-60 years, male predominance and subdural haemorrhage as the most frequent intracranial lesion following head trauma [2,24,25]. In a living systematic review of 66 studies from 23 European countries, Brazinova et al. examined the epidemiological patterns in patients with TBI from the full severity spectrum (mild, moderate and severe) based on ICD-8, 9 and 10 diagnoses as well as clinical definitions [13]. ...
Background
Traumatic brain injury (TBI) is a potential high-risk condition, but appropriate care pathways, including prehospital triage and primary referral to a specialised neurosurgical centre, can improve neurological outcome and survival. The care pathway starts with layman triage, wherein the patient or bystander decides whether to contact a general practitioner (GP) or emergency services (1-1-2 call) as an entryway into the health care system. The GP or 112-health care professional then decides on the level of urgency and dispatches emergency medical services (EMS) when needed. Finally, a decision is made regarding referral of the TBI patient to a specialised neurotrauma centre or a local hospital. Recent studies have shown that injuries are generally more severe in patients entering the health care system through EMS (112-calls) than through GPs; however, no information exists on whether mortality and morbidity outcomes differ depending on the referral choice. The aim of this study was to examine triage pathways, including the method of entry into the health care system, as well as patient characteristics and place of primary referral, to determine the associated 30-day and 1-year mortality rates in TBI patients with confirmed intracranial lesions.
Methods
This retrospective observational population-based follow-up study was conducted in the Central Denmark Region from 1 February 2017 to 31 January 2019. We included all adult patients who contacted hospitals and were ascribed a predefined TBI ICD-10 diagnosis code in the Danish National Patient Register. The obtained TBI cohort was merged with prehospital data from the Prehospital Emergency Medical Services, Central Denmark Region, and vital status from the Danish Civil Registration System. Binary logistic regression analysis of mortality was conducted. In all patients with TBI (including concussions), the primary outcome was primary referral to a specialised centre based on mode of entry (‘GP/HCP’, ‘112-call’ or ‘Unreferred’) into the health care system. In the subgroup of patients with confirmed intracranial lesions, the secondary outcomes were the relative risk of death at day 30 and 1 year based on the place of primary referral.
Results
Of 5,257 first TBI hospital contacts of adult patients included in the cohort, 1,430 (27.2%) entered the health care system via 1-1-2 emergency medical calls. TBI patients triaged by 112-calls were more likely to receive the highest level of emergency response (15.6% vs. 50.3%; p < 0.001) and second-tier resources and were more frequently referred directly to a specialised centre than were patients entering through GPs or other health care personnel. In the subgroup of 1188/5257 (22.4%) patients with confirmed intracranial lesions, we found no difference in the risk ratio of 30 day (RR 1.04 (95%CI 0.65–1.63)) or 1 year (RR 0.96 (95%CI 0.72–1.25)) all-cause mortality between patients primarily referred to a regional hospital or to a specialised centre when adjusting for age, sex, comorbidities, antiplatelet/anticoagulant treatment and type of intracranial lesions.
Conclusion
TBI patients mainly enter the health system by contact with GPs or other health care professionals. However, patients entering through 112-calls are more frequently triaged directly to specialised centres. We were unable to demonstrate any significant difference in the adjusted 30-day and 1-year mortality based on e primary referral to a specialised centre. The inability to demonstrate an effect on mortality based on primary referral to a specialised centre may reflect a lack of clinical data in the registries used. Considerable differences may exist in nondocumented baseline characteristics (i.e., GCS, blood pressure and injury severity) between the groups and may limit conclusions about differences in mortality. Further research providing high-quality evidence on the effect of primary referral is needed to secure early neurosurgical interventions in TBI patients.
... [1][2][3][4][5][6][7] Head trauma can have as a result traumatic brain injuries (TBIs). 8 They can either be primary or secondary. Primary traumatic injuries can be severe and life threatening, and their presence needs to be documented in order to set the correct therapeutic conduct. ...
... 9 Boys are more frequently victims of head trauma, no matter the age group. 7,8,10,11 When we take age into consideration, things differ from region to region worldwide. In Europe, for example, in a 2014 study based on the reports from 33 countries, the highest incidence is for the 0-4 years group. ...
Head trauma in paediatric patients is a worldwide and constant issue. It is the number one cause for childhood mortality and morbidity. Children of all ages are susceptible to sustaining head trauma and the anatomical characteristics of the region put them in a high-risk category for developing severe traumatic brain injuries. Boys are more frequently victims of accidental head traumas, and their injuries are more severe than those encountered in girls. The mechanisms of the trauma are a determining factor for the types of lesions we find. The traumatic injuries fall into two categories, primary and secondary. Primary traumatic injuries can be severe and life threatening, and their presence needs to be documented in order to set the correct therapeutic conduct. Due to their importance, this pictorial review focuses on them and the images used herein are selected from the database of our hospital. It is important to distinguish each of the different injuries that can be encountered. At the same time, radiologists are advised to remember that for children up to five years of age, some non-accidental imaging findings may appear to coincide with those found in accidental head trauma.
... In 594 TBI patients with ophthalmic findings, 28.0-51.8% suffered eyelid ecchymosis, 38.6-44.4% subconjunctival haemorrhage, 43.1% chemosis, 41.4% lid oedema, and 22.5% a lacerating injury [6][7][8][9]. Classical traumatic optic neuropathy (TON) is reported in 0.5-8% of civilian TBI cases [10][11][12][13][14][15]. ...
... The studies were all small and may have lacked power. TON detected by ophthalmologists in routine practice is a relatively rare condition, with one UK British Ophthalmic Surveillance Unit study reporting an annual incidence of 1.005 per million population [42], which is clearly at odds with the 0.5-8% frequency reported in civilian TBI cases [10][11][12][13][14][15], and the 31-47% suffering subclinical TON [20][21][22], given the annual incidence of TBI, which is 258 per 100,000 in Europe with more than 350,000 hospital admissions annually in the UK [43,44]. One reason for the lack of studies may therefore be underdiagnosis of the condition by ophthalmologists. ...
Background
Traumatic optic neuropathy is classically described in up to 8% of patients with traumatic brain injury (TBI), but subclinical or undiagnosed optic nerve damage is much more common. When more sensitive testing is performed, at least half of patients with moderate to severe TBI demonstrate visual field defects or optic atrophy on examination with optical coherence tomography. Acute optic nerve compression and ischaemia in orbital compartment syndrome require urgent surgical and medical intervention to lower the intraocular pressure and diminish the risk of permanent optic nerve dysfunction. Other manifestations of traumatic optic neuropathy have more variable treatments in international practice.
Methods
We conducted a systematic review of traumatic optic neuropathy treatments in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.
Results
We included three randomised controlled trials of intravenous methylprednisolone (IVMP), erythropoietin, and levodopa-carbidopa combination, with no evidence of benefit for any treatment. In addition, large studies in TBI have found strong evidence of increased mortality in patients treated with megadose IVMP.
Conclusions
There is therefore no evidence of benefit for any medical treatment and strong evidence of harm from IVMP. There is also no evidence of benefit for optic canal decompression for traumatic optic neuropathy. Orbital compartment syndrome is a separate entity that requires both medical and surgical interventions to prevent visual loss.
... Traumatic brain injury (TBI) is a pressing, multifaceted health concern affecting millions of people worldwide annually. [1][2][3] The initial clinical severity of TBI is commonly reported according to the Glasgow Coma Scale (GCS), which is often trichotomized into three classes of severity: mild (GCS [13][14][15], moderate (GCS 9-12) and severe (GCS≤8). This tripartite division is embedded in clinical practice and research, but neglects patient experiences and the relevant heterogeneity within the divisions. ...
Objective: To compare the incremental prognostic value of pupillary reactivity as captured in the GCS-Pupils score (GCS-P) or added as separate variable to the Glasgow Coma Scale (GCS) in traumatic brain injury (TBI).
Methods: We analyzed patients enrolled between 2014 and 2018 in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI, n=3521) and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI, n=1439) cohorts. We used logistic regression to quantify the prognostic performances of GCS-P versus GCS according to Nagelkerke R2. Endpoints were mortality and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-4) at 6 months after injury. We estimated 95% confidence intervals with bootstrap resampling to summarize the improvement in prognostic capability.
Results: GCS as a linear score had a R2 of 24% (95% confidence interval [CI] 17-30) and 30% (95%CI 17-43) for mortality and 29% (95%CI 25-34) and 38% (95%CI 29-47) for unfavorable outcome in CENTER-TBI and TRACK-TBI respectively. In the meta-analysis, pupillary reactivity as a separate variable improved the R2 by an absolute value of 6% and 2% for mortality and unfavorable outcome (95%CI 4.0-7.7 and 1.2-3.0, respectively), with half the improvement captured in the GCS-P score (3%, 95%CI 2.1-3.3 and 1%, 95%CI 1-1.7, respectively).
Conclusions: GCS-P has a stronger association with outcome after TBI than the GCS alone. However, for prognostic models, inclusion of GCS and pupillary reactivity as separate scores is preferable.
... (country-level), and 3.3 -24.4/100,000/year (regional-level). Similar to the USA, the most common reasons of injury were traffic accidents and falls [4]. Majdan et al. reported occurrence of a total of 17,049 TBI-related deaths (translating into 374,636 years of lost lives, YLLs) in 16 European countries Disclaimer/Publisher's Note: The statements, opinions, and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). ...
Traumatic brain injury (TBI) is an important global clinical issue, requiring not only prevention but also effective treatment. Following TBI, diverse parallel and intertwined pathological mechanisms affecting biochemical, neurochemical, and inflammatory pathways can have severe impact on the patient’s quality of life. The current review summarizes evidence for utility of amantadine in TBI in connection to its mechanism of action. Amantadine combining multiple mechanisms of action may offer both neuroprotective and neuroactivating effects in TBI patients. Indeed, use of amantadine in TBI has been encouraged by several clinical practice guidelines/recommendations. Amantadine is also available as infusion which may be of particular benefit in unconscious patients with TBI, due to immediate delivery to the central nervous system and the possibility of precise dosing. In other situations, orally administered amantadine may be used. There are several questions that remain to be addressed: Can amantadine be effective in disorders of consciousness requiring long-term treatment and in combination with drugs approved for treatment of TBI? Do the observed beneficial effects of amantadine extend to disorders of consciousness due to factors other than TBI? Well controlled clinical studies are warranted to ultimately confirm its utility in the TBI and provide answers these questions.
... Traumatic Brain Injury (TBI) remains a critical global health concern with profound socio-economic and public health implications [1,2]. TBI affects individuals across a wide spectrum of demographics, but the specific risk factors, outcomes, and mechanisms of injury can vary significantly among different groups [3,4]. ...
Traumatic Brain Injury (TBI) stands as a multifaceted health concern, exhibiting varying influences across human population. This study delves into the biomechanical complexities of TBI within gender-specific contexts, focusing on females. Our primary objective is to investigate distinctive injury mechanisms and risks associated with females, emphasizing the imperative for tailored investigations within this cohort.
By employing Fluid-Structure Interaction (FSI) Analysis, we conducted simulations to quantify biomechanical responses to traumatic forces across diverse age groups of females. The study utilized a scaling technique to create finite element models (FEMs). The young female FEM, based on anthropometric data, showcased a 15 % smaller head geometry compared to the young male FEM. Moreover, while the elderly female FEM closely mirrored the young female FEM in most structural aspects, it showed distinctive features such as brain atrophy and increased cerebrospinal fluid (CSF) layer thickness. Notably, the child female FEM (ages 7–11 years) replicated around 95 % of the young female FEM's geometry. These structural distinctions meticulously captured age-specific variations across our modeled female age groups. It's noteworthy that identical conditions, encompassing impact intensity, loading type, and boundary conditions, were maintained across all FEMs in this biomechanical finite element analysis, ensuring comparative results.
The findings unveiled significant variations in frontal and occipital pressures among diverse age groups, highlighting potential age-related discrepancies in TBI susceptibility among females. These variations were primarily linked to differences in anatomical features, including brain volume, CSF thickness, and brain condition, as the same material properties were used in the FEMs. These results were approximately 4.70, 6.33 and 6.43 % in frontal area of brain in diverse age groups of females (young, elderly, and child) respectively compared to young male FEM. Comparing the FEM results between the young female and the elderly female, we observed a decrease in occipital brain pressure at the same point, reducing from 171,993 to 167,793 Pa, marking an approximate 2.5 % decrease. While typically the elderly exhibit greater brain vulnerability compared to the young, our findings showcase a reduction in brain pressure. Notably, upon assessing the relative movement between the brain and the skull at the point located in occipital area, we observed greater relative movement in the elderly (1.8 mm) compared to the young female (1.04 mm). Therefore, brain atrophy increases the range of motion of the brain within the cranial space. The study underscores the critical necessity for nuanced TBI risk assessment tailored to age and gender, emphasizing the importance of age-specific protective strategies in managing TBIs across diverse demographics. Future research employing individual modeling techniques and exploring a wider age spectrum holds promise in refining our understanding of TBI mechanisms and adopting targeted approaches to mitigate TBI in diverse groups.
... Furthermore, between 1990 and 2016, trends in the agestandardized prevalence of TBI increased by 8.4% [18]. In Europe, a large variability has been reported in crude TBI incidence (ranging from 47.3 to 694 per 100,000) and mortality rates (from 9 to 28.10 per 100,000) with large differences based on whether the study was conducted at a regional or a country level [7,12]. TBI is associated with significant disability and imposes a substantial burden on affected individuals, families, and healthcare services. ...
Background
Traumatic brain injury (TBI) is a severe condition that represents a major global public health concern.
Objectives
Provide a comprehensive epidemiological outlook encompassing TBI incidence, healthcare provision and mortality.
Methods
Population-based study in Veneto (4.9 million inhabitants), Italy, from 2012 to 2021. Hospital discharge and mortality records were used to assess incidence and mortality. Kaplan–Meier survival estimator and Cox regression models were fitted to investigate determinants of mortality.
Results
Between 2012 and 2021, there were 37,487 incident TBI cases, corresponding to an age-standardized rate of 77.30/100,000 people (95% CI 76.52–78.09), higher among males, with an exponential growth after age 70. Leading causes were domestic (33.1%) and traffic accidents (17.7%), the first predominating among the elderly and children, while the latter in males 15–24 and older people. After rates stably declined between 2012 and 2019, the study captured a sharp decrease especially for traffic and occupational accidents in males, due to COVID-19 lockdown in 2020. Overall, 48.9% TBI patients were hospitalized in a specialized trauma center, with 2.6% requiring a transfer after accessing a spoke hospital. Over a 3.7 years median follow-up, 16,145 deaths were recorded, with higher mortality for those undergoing neurosurgical interventions, regardless of their access point. Risks of death increased with age, male gender, and comorbidities.
Discussion
TBI incidence is characterized by distinct patterns, affecting particularly older individuals and males. Minimal hospital transfers with comparable survival irrespective of access point suggests an effective patient management within the network. The study underscores the critical need for acute-phase support and prolonged care strategies for older TBI patients.
... E ach year in Europe, severe traumatic brain injury (TBI) causes an estimated 82,000 deaths with current trends indicating consistent annual increases despite widespread efforts and awareness to combat this "silent epidemic." [1][2][3] An important complication of severe TBI is increased intracranial pressure (ICP) due to severe brain swelling posttrauma or the mass effect arising from the primary lesion. Decompressive craniectomy (DC) is the treatment of last resort for medically refractory ICP and can be performed as part of a primary procedure (after immediate evacuation of a mass lesion) or as a secondary procedure (to treat medically refractory ICP elevation). 4 As a secondary treatment, it allows immediate outward expansion of brain tissue, lowers ICP, and consequently improves cerebral blood flow. ...
... It is estimated that only approximately 20% of concussions are sports-related [6,7], with the majority of concussions resulting from falls, pedestrian and vehicle-related road crashes, and assaults, including intimate partner violence [8][9][10][11][12]. Concussion has been repeatedly identified as being under-reported in sporting populations [13][14][15] and while it is assumed that under-reporting of non-sports-related concussions also remains high, there is a lack of evidence to support this due to limited literature on non-sports-related concussions. ...
Aim: Indigenous Australians have higher rates of traumatic brain injury, with 74–90% of such injuries being concussion. This study explores concussion awareness and knowledge in Aboriginal Western Australians with high health literacy. Materials & methods: Participants, aged 18–65 years, engaged in research topic yarning, and thematic analysis of the qualitative data then undertaken. Results: There was awareness that direct head trauma can result in concussion, but a lack of differentiation between concussion and other head injuries. Knowledge was gained from sport, media or lived-experience. Symptom minimization and diversity of concussion symptoms prevented participants from seeking medical treatment. This was exacerbated by a mistrust of the medical system. Conclusion: Research findings highlight knowledge and service gaps where co-designed strategies can be targeted.
... Some patients had received certain additional components of CP such as hyperosmolar therapy, thiopentone coma, hypothermic therapy and surgical interventions. As a result of these holistic approach, this study showed fatality rate of 17.4% at ICU discharge which is slightly less than mortality of 18% in systematic review in Europe (12). Higher fatality was seen in this systemic review because they compile all mortality over longer time frame which differ from our study that had shorter time limit to 1 month after ICU discharge. ...
Background
Severe traumatic brain injury (TBI) is a leading cause of disability worldwide and cerebral protection (CP) management might determine the outcome of the patient. CP in severe TBI is to protect the brain from further insults, optimise cerebral metabolism and prevent secondary brain injury. This study aimed to analyse the short-term Glasgow Outcome Scale (GOS) at the intensive care unit (ICU) discharge and a month after ICU discharge of patients post CP and factors associated with the favourable outcome.
Methods
This is a prospective cohort study from January 2021 to January 2022. The short-term outcomes of patients were evaluated upon ICU discharge and 1 month after ICU discharge using GOS. Favourable outcome was defined as GOS 4 and 5. Generalised Estimation Equation (GEE) was adopted to conduct bivariate GEE and subsequently multivariate GEE to evaluate the factors associated with favourable outcome at ICU discharge and 1 month after discharge.
Results
A total of 92 patients with severe TBI with GOS of 8 and below admitted to ICU received CP management. Proportion of death is 17% at ICU discharge and 0% after 1 month of ICU discharge. Proportion of favourable outcome is 26.1% at ICU discharge and 61.1% after 1 month of ICU discharge. Among factors evaluated, age (odds ratio [OR] = 0.96; 95% CI: 0.94, 0.99; P = 0.004), duration of CP (OR = 0.41; 95% CI: 0.20, 0.84; P = 0.014) and hyperosmolar therapy (OR = 0.41; CI 95%: 0.21, 0.83; P = 0.013) had significant association.
Conclusion
CP in younger age, longer duration of CP and patient not receiving hyperosmolar therapy are associated with favourable outcomes. We recommend further clinical trial to assess long term outcome of CP.
