scholarly journals Classification of traumatic brain injury severity using retrospective data

2017 ◽  
Vol 7 (11) ◽  
pp. 23
Author(s):  
Sandra Rogers ◽  
Amber W. Trickey
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Motor Vehicle ◽  
The United States ◽  
Retrospective Data ◽  
Trauma Centers ◽  
Classification Methods ◽  
Severity Classification ◽  
Brain Injured

Objective: Accurate classification of traumatic brain injury (TBI) severity is essential to brain injury research. TBI heterogeneity complicates classification of the injury; is a significant barrier in the design of therapeutic interventions; and results in retrospective data which is difficult to translate. The objective of this study is to describe the differences in two current tools used in the classification of TBI severity, the Glasgow Coma Scale (GCS) and the head Abbreviated Injury Score (AIS), using retrospective data to compare their performance.Methods: Using correlational and descriptive statistics, this study examined two TBI severity classification methods across a large sample of TBI patients (N = 56,131), who were treated at level I and level II trauma centers in the United States and were included in the 2010 National Sample Program (NSP) of the National Trauma Data Bank (NTDB®).Results: The study population was 67% male, 67% non-Hispanic white, treated most often in trauma centers in the South (38%), with blunt trauma (93%) and from non-motor vehicle collisions (MVC’s) (56%). Observation of the AIS classification system demonstrated that it tends to over-score TBI severity compared to the GCS classification. The methods (GCS & AIS) had a weak, inverse relationship with a correlation coefficient (Pearson’s r) of -0.3980, which was significant at p < .001.Conclusions: The current study addressed the difficulties associated with categorizing TBI severity when analyzing retrospective data.  Although AIS is commonly used to classify severity in retrospective data when GCS is unavailable, the relationship between the two scales is relatively unknown. Results show that AIS and GCS are more closely related for severely brain injured patients but in cases of mild and moderate injury, AIS is less predictive of GCS. Since they are often used in conjunction in identifying brain injured severity in retrospective data, researchers cannot be certain that the tools are similarly classifying mild, moderate, and severe injuries. This study reinforces the need for additional TBI severity classification methods, such as neuroimaging techniques and biomarkers.

scholarly journals Developing an Adjunct to an Electronic Medical Records System in a Developing Country: Establishing the First Electronic Traumatic Brain Injury Database in Yangon, Myanmar

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Aung Thurein Win ◽  
Su Myat Moe ◽  
Nang Saw Myat Hnin Aye ◽  
Aye Mya Phyu ◽  
Thet Maung Maung ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Rate ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Motor Vehicle ◽  
Road Traffic ◽  
Postoperative Mortality ◽  
Transport Systems ◽  
Trauma Centers

Abstract INTRODUCTION Traumatic brain injury (TBI) is a frequent cause of admission and fatality in Myanmar, secondary to a high number of road traffic accidents. In a country of over 50 million, trauma centers serve less than 4% of the population. North Okkalappa General Hospital (NOGH) is 1 of 3 trauma centers in Yangon providing significant care for patients with TBI. In this pilot study, we collected prospective data encompassing patient demographics, nature of injury, intervention, and outcome at a tertiary trauma center (NOGH). METHODS Neurosurgery residents utilized an iPad-driven database management online software (Redcap) to document TBI admissions, treatment, and outcomes prospectively between November 2018 and April 2019. The data was monitored and analyzed weekly by the supervising physicians at the Henry Ford Hospital in Detroit, Michigan. RESULTS There were 242 TBI admissions (mean Glasgow Coma Scale (GCS) 12.97) during the study's timeline. Etiologies consisted of motorcycle accidents (n = 130), falls (n = 45), assaults (n = 39), pedestrian–motor vehicle accidents (n = 21), industrial accidents (n = 7), and other (n = 7). A total of 50 patients presenting with GCS < 8 were admitted directly or transferred to NOGH leading to a mortality rate of 68% during hospitalization. Neurosurgery was performed in 33 patients (14%) with a 24% postoperative mortality rate. CONCLUSION Poor outcomes after severe TBI in Myanmar are multifactorial including a lack of access-to-care, suboptimal patient management (eg, pre-hospital, in-hospital and postoperative) and limited resources (eg, ventilators, arterial lines, etc.). Additionally, critical care expertise is limited. Overall, in this study we were able to establish a robust database in a research and electronic medical records-naïve location, serving to study and characterize TBI patients. Improved TBI care at local and national levels requires public education, efficient transport systems, geographically strategic trauma centers and improved in-hospital patient care. Government funding and international neurosurgery support is essential.

scholarly journals Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations

2020 ◽  
Vol 10 (3) ◽  
pp. 135 ◽  
Author(s):  
John K. Yue ◽  
Pavan S. Upadhyayula ◽  
Lauro N. Avalos ◽  
Tene A. Cage
Keyword(s):  
Mental Health ◽  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Healthcare Costs ◽  
Motor Vehicle ◽  
The United States ◽  
Pubmed Database ◽  
Pediatric Tbi

Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/head trauma” OR “brain/head injury”) AND “rural/underserved” AND “pediatric/child”). All qualifying articles focusing on rural pediatric TBI, including the subtopics epidemiology (N = 3), intervention/healthcare cost (N = 6), and prevention (N = 1), were reviewed. Results: Rural pediatric TBIs were more likely to have increased trauma and head injury severity, with higher-velocity mechanisms (e.g., motor vehicle collisions). Rural patients were at risk of delays in care due to protracted transport times, inclement weather, and mis-triage to non-trauma centers. They were also more likely than urban patients to be unnecessarily transferred to another hospital, incurring greater costs. In general, rural centers had decreased access to mental health and/or specialist care, while the average healthcare costs were greater. Prevention efforts, such as mandating bicycle helmet use through education by the police department, showed improved compliance in children aged 5–12 years. Conclusions: U.S. rural pediatric patients are at higher risk of dangerous injury mechanisms, trauma severity, and TBI severity compared to urban. The barriers to care include protracted transport times, transfer to less-resourced centers, increased healthcare costs, missing data, and decreased access to mental health and/or specialty care during hospitalization and follow-up. Preventative efforts can be successful and will require an improved multidisciplinary awareness and education.

Traumatic Brain Injury: Mechanical Response of Porcine Brain Under High Strain Rate Tests

2009 ◽  
Author(s):  
Raj Prabhu ◽  
Mark Horstemeyer ◽  
Esteban Marin ◽  
Jun Liao ◽  
Matt Tucker ◽  
...  
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Traffic Accidents ◽  
Mechanical Response ◽  
Motor Vehicle ◽  
The United States ◽  
Functional Changes ◽  
Mechanical Insult

The brain is one of the most critical organs of the human body during life-threatening and injury sustaining accidents. Traumatic brain injury (TBI) due to mechanical insult of the head is a leading cause of death and life-long disability in the United States. The Center for Disease Control (CDC) has estimated that, on average, 1.4 million Americans sustain TBI every year, 20% of which are the result of motor vehicle-traffic accidents. Nearly 50,000 people die of TBI each year. Around 5.3 million Americans currently have long-term disabilities after sustaining a TBI. Some of these long-term disabilities are linked to functional changes affecting thinking, sensation, language and emotions [1]. Direct and indirect medical costs related to TBI amounted to an estimated $60 billion in the United States in 2000 [2]. TBIs have a deep impact on our society and require effective protective measures to curb consequent injuries and disabilities [3].

Rotational Acceleration Duration Affects Brain Strains in Lateral Impact

2007 ◽  
Author(s):  
Jianrong Li ◽  
Jiangyue Zhang ◽  
Narayan Yoganandan ◽  
Frank A. Pintar ◽  
Thomas A. Gennarelli
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Motor Vehicle ◽  
Angular Acceleration ◽  
The United States ◽  
Physical Models ◽  
Lateral Impact ◽  
Diffuse Brain Injury ◽  
Diffuse Brain

Traumatic brain injury is a leading cause of disability and fatality in the United States. Approximately two million traumatic brain injury cases occur every year [1]. Motor vehicle crashes are a primary source [2]. Both clinical and laboratory studies have been conducted to understand injury mechanisms and establish injury thresholds [3, 4]. Physical models have also been used to investigate injury biomechanics [5, 6]. Angular acceleration is considered as a major cause of diffuse brain injuries (DBI) [7, 8], while the angular velocity is chosen as a suitable load descriptor for a diffuse brain injury criterion [4]. The present study is focused on the effect of angular acceleration duration on brain strains due to lateral impact.

Traumatic Brain Injury: A Trauma Surgeon's Perspective

2012 ◽  
Vol 22 (3) ◽  
pp. 82-89
Author(s):  
Oscar D. Guillamondegui
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multidisciplinary Approach ◽  
Trauma Team ◽  
The United States ◽  
Long Term Outcomes ◽  
Term Care ◽  
Injured Brain ◽  
The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

2020 ◽  
pp. 1-10
Author(s):  
Brittany M. Stopa ◽  
Maya Harary ◽  
Ray Jhun ◽  
Arun Job ◽  
Saef Izzy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Data Bank ◽  
The United States ◽  
National Sample ◽  
Population Based ◽  
Weighted Estimates ◽  
True Incidence ◽  
Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

Classification of the Spectrum of Mild Traumatic Brain Injury

Brain Injury ◽  
1995 ◽  
Vol 9 (4) ◽  
pp. 417-424 ◽  
Author(s):  
P. C. Esselman ◽  
J. M. Uomoto
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury

scholarly journals Adult sports-related traumatic brain injury in United States trauma centers

2016 ◽  
Vol 40 (4) ◽  
pp. E4 ◽  
Author(s):  
Ethan A. Winkler ◽  
John K. Yue ◽  
John F. Burke ◽  
Andrew K. Chan ◽  
Sanjay S. Dhall ◽  
...  
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Health Concern ◽  
Medical Complications ◽  
Equestrian Sports ◽  
Prolonged Hospital

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories—fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CONCLUSIONS Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use—particularly in equestrian and roller sports—are critical elements for decreasing sports-related TBI events in adults.

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