Trends in Hospitalization Associated with TBI in an Urban Level 1 Trauma Centre

Objective:Traumatic brain injury (TBI) is the single largest cause of death and disability following injury worldwide. The aim of this study was to determine the demographic, clinical, medical and accident related trends for patients with TBI hospitalized in an urban level 1 Trauma Centre.Methods:Data were retrospectively collected on individuals (n = 5,642) who were admitted to the Traumatic Brain Injury Program of the McGill University Health Centre - Montreal General Hospital from 2000 to 2011.Results:Regression analysis showed a significant upward trend in the yearly number of cases as well as an upward trending by year in the proportion of TBI cases aged 70-years-old or more. The Injury Severity Scale scores were positively associated with year indicating a slight increase in injury severity over the years and there was an increase in patient psychological, social and medical premorbid complexity. In addition, the Extended Glasgow Outcome Scale score tended to become more severe over the years. There was a slight decrease in the proportion of discharges home and in the proportion of deaths.Conclusions:These results will help to understand the impact of TBI in an urban Canadian level 1 Trauma Centre. This information should be used to develop public prevention strategies and to educate the community about the risk of TBI especially the risk of falls in the ageing population. These findings can also provide information to help health policy makers plan for future resources.

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The impact of blood ethanol concentration on the classification of head injury severity in traumatic brain injury

Brain Injury ◽

10.3109/02699052.2015.1075154 ◽

2015 ◽

Vol 29 (13-14) ◽

pp. 1648-1653 ◽

Cited By ~ 7

Author(s):

Pål Rønning ◽

Per Ole Gunstad ◽

Nils-Oddvar Skaga ◽

Iver Arne Langmoen ◽

Knut Stavem ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Injury Severity ◽

Ethanol Concentration ◽

Blood Ethanol Concentration ◽

The Impact ◽

Head Injury Severity

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Early versus Late Tracheostomy: Is There an Outcome Difference?

The American Surgeon ◽

10.1177/000313481908500427 ◽

2019 ◽

Vol 85 (4) ◽

pp. 370-375 ◽

Cited By ~ 7

Author(s):

Adel Elkbuli ◽

Raed Ismail Narvel ◽

Paul J. Spano ◽

Valerie Polcz ◽

Astrid Casin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Primary Outcome ◽

Injury Severity ◽

Future Research ◽

Trauma Patients ◽

Early Tracheostomy ◽

Outcome Difference ◽

The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

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Adapting the Canadian CT head rule age criteria for mild traumatic brain injury

Emergency Medicine Journal ◽

10.1136/emermed-2018-208153 ◽

2019 ◽

Vol 36 (10) ◽

pp. 617-619 ◽

Cited By ~ 2

Author(s):

Nicolas Fournier ◽

Charles Gariepy ◽

Jean-François Prévost ◽

Vincent Belhumeur ◽

Émile Fortier ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Trauma Centre ◽

Ageing Population ◽

Predictive Capacity ◽

Radiological Data ◽

Future Prospective Study ◽

Ct Head ◽

Proposed Modification

ObjectiveWith the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity.MethodsWe conducted a retrospective cohort study at a level 1 trauma centre ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014. Main outcome was a clinically important brain injury (CIBI) reported on CT. The clinical and radiological data collection was standardised. Univariate analyses were performed to measure the predictive capacities of different age cut-offs at 70, 75 and 80 years old.Results104 confirmed mTBI were included; CT scan identified 32 (30.8%) CIBI. Sensitivity and specificity (95% CI) of the CCHR were 100% (89.1 to 100) and 4.2% (0.9 to 11.7) for a modified criteria of 70 years old; 100% (89.1 to 100) and 13.9% (6.9 to 24.1) for 75 years old; and 90.6% (75.0 to 98.0) and 23.6% (14.4 to 35.1) for 80 years old. Furthermore, modifying the age criteria to 75 years old showed a reduction of CT up to 25% (n=10/41) among the individuals aged 65–74 without missing CIBI.ConclusionAdjusting the age criteria of the Canadian CT head rule to 75 years old could be safe while reducing radiation and ED resources. A future prospective study is suggested to confirm the proposed modification.

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Anemia and Blood Transfusion in Patients with Isolated Traumatic Brain Injury

Critical Care Research and Practice ◽

10.1155/2015/672639 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Hasan M. Al-Dorzi ◽

Waleed Al-Humaid ◽

Hani M. Tamim ◽

Samir Haddad ◽

Ahmad Aljabbary ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Transfusion ◽

Hospital Mortality ◽

Injury Severity ◽

Tertiary Care ◽

Hemoglobin Level ◽

Secondary Insult ◽

The Impact ◽

Present On Admission

Rationale. By reducing cerebral oxygen delivery, anemia may aggravate traumatic brain injury (TBI) secondary insult. This study evaluated the impact of anemia and blood transfusion on TBI outcomes.Methods. This was a retrospective cohort study of adult patients with isolated TBI at a tertiary-care intensive care unit from 1/1/2000 to 31/12/2011. Daily hemoglobin level and packed red blood cell (PRBC) transfusion were recorded. Patients with hemoglobin < 10 g/dL during ICU stay (anemic group) were compared with other patients.Results. Anemia was present on admission in two (2%) patients and developed in 48% during the first week with hemoglobin < 7 g/dL occurring in 3.0%. Anemic patients had higher admission Injury Severity Score and underwent more craniotomy (50% versus 13%,p<0.001). Forty percent of them received PRBC transfusion (2.8 ± 1.5 units per patient, median pretransfusion hemoglobin = 8.8 g/dL). Higher hospital mortality was associated with anemia (25% versus 6% for nonanemic patients,p=0.01) and PRBC transfusion (38% versus 9% for nontransfused patients,p=0.003). On multivariate analysis, only PRBC transfusion independently predicted hospital mortality (odds ratio: 6.8; 95% confidence interval: 1.1–42.3).Conclusions. Anemia occurred frequently after isolated TBI, but only PRBC transfusion independently predicted mortality.

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Behavioural Profiles and Injury Severity Following Childhood Traumatic Brain Injury

Brain Impairment ◽

10.1375/brim.8.1.22 ◽

2007 ◽

Vol 8 (1) ◽

pp. 22-30 ◽

Cited By ~ 14

Author(s):

Suzanne L. Barker-Collo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Stay ◽

Child Behavior Checklist ◽

Injury Severity ◽

Attention Problems ◽

Normal Limits ◽

Orthopaedic Injury ◽

Severe Tbi ◽

The Impact

AbstractTraumatic brain injury (TBI) is a leading cause of death and morbidity in children and can result in cognitive, behavioural, social and emotional difficulties that may impact quality of life. This study examined the impact of mild, moderate, and severe childhood TBI, when compared to severe orthopaedic injury, on behaviour as measured by the Child Behavior Checklist (CBCL) in a sample of 74 children with TBI and 13 with orthopaedic injury aged 4 to 13 years at the time of injury. Correlational analyses revealed that within the TBI sample increased anxiety/depression and somatisation were related to increased age at the time of injury and shorter inpatient hospital stay. Increased age was also related to increased parental reports of attention problems; while increased hospital stay was related to increased withdrawal and thought problems. Symptomatology was within normal limits for all groups, approaching the borderline clinical range in the moderate TBI group for somatic symptoms and in the severe TBI group for thought and attention problems. Those with severe TBI had more thought and attention problems, and to a lesser extent social problems, than those with mild or moderate TBI; while those with moderate TBI had the highest levels of somatic and anxious–depressed symptoms. The only scale where performance seemed to increase in relation to injury severity was the attention problems scale. It is suggested that the findings for those with moderate TBI reflect increased awareness of one's own vulnerability/mortality, with the implication that issues such as grief, loss, and mortality may need to be addressed therapeutically.

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P.184 Off-road vehicle fatalities and alcohol in patients with major traumatic brain injury: the risk of impaired driving

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.460 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S73-S73

Author(s):

S Walling ◽

N Kureshi ◽

DB Clarke ◽

M Erdogan ◽

RS Green

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Injury Severity ◽

Alcohol Intoxication ◽

Blood Alcohol Concentration ◽

Significant Risk ◽

Road Vehicle ◽

Hospital Deaths ◽

The Impact

Background: Intoxicated patients injured in off road vehicle (ORV) crashes have higher rates of traumatic brain injury (TBI) and intensive care unit (ICU) admission, as well as prolonged ICU length of stay. This study evaluated the impact of alcohol intoxication on mortality among major TBI patients injured in off-road vehicle crashes. Methods: A retrospective analysis (2002-2014) of off-road vehicle injuries in Nova Scotia resulting in major TBI was performed. ORVs included ATVs, snowmobiles, and dirt bikes. A logistic regression model was constructed to test for in-hospital mortality and adjusted for age, Abbreviated Injury Scale (AIS) Head, Injury Severity Score, and blood alcohol concentration (BAC). Results: There were 176 drivers and passengers of off-road vehicles. Overall mortality was 28%. BAC testing was performed in 61% patients; 85% of pre-hospital deaths were BAC positive (mean BAC=31 ± 17.39 mmol/L) and 70% in-hospital deaths were BAC positive (mean BAC=26 ± 23.12 mmol/L). After adjusting for confounders, high injury severity and intoxication increased the likelihood of in-hospital mortality. Conclusions: These findings demonstrate that alcohol intoxication is a significant risk factor for mortality among off-road vehicle collisions; for every mmol/L change in BAC, there was a 10% increase in the chance of in-hospital mortality.

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Mechanism of death after early decompressive craniectomy in traumatic brain injury

Trauma ◽

10.1177/1460408616683208 ◽

2016 ◽

Vol 20 (3) ◽

pp. 175-182 ◽

Cited By ~ 1

Author(s):

FA Zeiler ◽

K Trickey ◽

L Hornby ◽

SD Shemie ◽

BWY Lo ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Decompressive Craniectomy ◽

Injury Severity ◽

Circulatory Arrest ◽

Multivariate Regression Analysis ◽

Societal Implications ◽

Severity Scores ◽

Significant Difference ◽

The Impact

Background Decompressive craniectomy in devastating traumatic brain injury is controversial. The impact of decompressive craniectomy on mechanism of death is unclear in the literature to date. Our goal was to determine the mechanism of death between those receiving early decompressive craniectomy and those managed medically. Methods We performed an institutional retrospective review, from June 2003 to June 2013, of adult patients with devastating blunt traumatic brain injury undergoing early decompressive craniectomy who subsequently died. We compared this group to a retrospectively matched group based on: age, pre-hospital KPS, Marshall diffuse computed tomography grades, Injury Severity Scores, and admission laboratory values. Results Forty patients were analyzed; 20 with decompressive craniectomy and 20 without. The two groups were similar based on admission demographics, with the only statistically significant difference being platelet levels. Upon analysis, through both univariate and multivariate regression analysis, the mechanism of death was significantly different (p = 0.003; OR: 0.07 (0.01–0.41) and p = 0.04; OR: 0.08 (0.01–0.87)) with the decompressive craniectomy and non-decompressive craniectomy groups displaying neurological death rates of 10.0% versus 60.0%, respectively, with all other patients in both groups dying secondary to circulatory arrest after withdrawal of life-sustaining therapy. Time to death was significantly longer in the decompressive craniectomy group (2.83 vs. 9.21 days, respectively) (p = 0.01; OR: 0.65 (0.46–0.91). Conclusions Progression to neurological death appears to be more common in those devastating blunt traumatic brain injury patients treated medically compared to those undergoing early decompressive craniectomy. Given the implications of end-of-life care and societal implications, the mechanism of death determination and organ donation should be reported as relevant outcomes in devastating traumatic brain injury studies.

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Early Prognostication after Traumatic Brain Injury: Specific Validation of the IMPACT Prognostic Calculator in a Level 1 Trauma Center

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685137 ◽

2019 ◽

Vol 80 (06) ◽

pp. 423-429

Author(s):

Anna Jung ◽

Felix Arlt ◽

Maciej Rosolowski ◽

Jürgen Meixensberger

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Trauma Center ◽

Roc Analysis ◽

Time Frame ◽

Extended Model ◽

Severe Tbi ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

AbstractThe present study evaluated the usefulness of the IMPACT prognostic calculator (IPC) for patients receiving acute neurointensive care at a level 1 trauma center in Germany. A total of 139 patients with traumatic brain injury (TBI) were assessed. One day after trauma, the extended model of the IPC was found to provide the most valid prediction of 6-month mortality/unfavorable outcome. Different time frames within the first day could be determined by analyzing mild, moderate, and severe TBI cohorts. The CORE + CT model at time frame Z2 (<6 h from the point of first documentation) for mild TBI exhibited the highest values in the receiver operating characteristic (ROC) analysis (area under the curve [AUC], 0.9; sensitivity, 1; specificity, 0.7). For patients with moderate head injury at time frame Z2/3 (<6–12 h from point of first documentation), the extended model fit best. For patients with severe TBI, the extended model at time frame Z6 (48–72 h from point of first documentation) best predicted 6-month mortality and unfavorable outcome (ROC analysis: AUC, 0.542/0.445; sensitivity, 0.167/0.364; specificity, 0.575/0.444). Center-specific validation demonstrated the validity of the IPC in the early phase after TBI. These findings support the usefulness of the IPC for predicting the prognosis of patients with TBI. However, further prospective validation using a larger TBI cohort is needed.

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