Cause Of Traumatic Brain Injury Research Articles

Assessment of Neurological Outcomes of Patients Following Emergency Neurosurgical Interventions for Intra-Cranial Hematomas in Traumatic Brain Injury at Yekatit 12 Hospital Medical College

Background: Traumatic Brain Injury (TBI) is the primary cause of death and disability in individuals under 40 globally. Resource constraints exist across the care spectrum, and neurosurgical outcomes remain poorly understood. Objective: The study aims to evaluate the short-term neurological outcomes of patients who underwent surgery for traumatic intracranial hemorrhage at Yekatit 12 Hospital Medical College. Patients and Methods: A longitudinal study design was used. Data were analyzed using SPSS version 27 and binary logistic regression was used to see factors associated with outcomes. P value ≤0.05 was considered significant Result: Total of 34 patients were studied male outnumbered female and mean was age 34.5 ± 12.8. Road traffic accident was the common cause of traumatic brain injury. Acute epidural hematoma accounted the highest proportion (46%) traumatic brain injury. Postoperative mortality rate was 17.6 % and 83.3% was secondary to acute subdural hematoma. On post-operative follow up 64.7% patients have favorable 3 month Glasgow outcome score. The initial pupillary reaction (P: 0.02 COR 0.02(0.002-0.205), postoperative complications (P: <0.01 COR 21(2.099-210.136) and length of hospital stay (P: 0.04 COR0.054(0.07-0.395) showed statically significant association with 03 month Glasgow outcome score. Conclusion: Young male populations are predominately affected from traumatic brain injury. Initial pupillary reactions and postoperative complications significantly affect the neurologic outcome.

Part 1: Evaluating Neck-Strengthening Protocols to Reduce the Incidence of Traumatic Brain Injury: Traditional vs. Nontraditional Neck-Strengthening Techniques

Abstract Schroeder, LH, McDaniel, AT, Wang, Y, Dickens, GM, Pantani, V, and Kubinak, H. Part 1: evaluating neck-strengthening protocols to reduce the incidence of traumatic brain injury: traditional vs. nontraditional neck-strengthening techniques. J Strength Cond Res 38(1): 21–29, 2024—A common cause of traumatic brain injuries (TBIs) is the head's kinematic response to rapid movement, which can be reduced with dynamic neck strengthening. This study aimed to determine the most effective neck-strengthening program by comparing a traditional and nontraditional program. Isometric neck strength was assessed in 32 subjects randomly assigned to one of the traditional and nontraditional neck-strengthening programs. The nontraditional program used a novel neck-strengthening device. After weeks 6 and 10 of training, isometric neck strength was reassessed. With the collected data, linear mixed models were established to compare the changes in neck strength between the 2 groups during the 10-week training period. Statistical analysis results suggest that, for both cervical extension (CE) and cervical flexion (CF), subjects in the novel neck-strengthening device group had a significantly higher gain of strength during the 10 weeks than the traditional group. With test statistics of −2.691 and −3.203 and corresponding 2-sided p-value of 0.01289 and 0.003889, respectively, we conclude that there is a statistically significant difference in the linear slopes of increase for both CE and CF between the 2 groups. As to left cervical lateral flexion and right cervical lateral flexion, the novel neck strength group had increased strength gains compared with the traditional group. However, the increase was not enough to demonstrate significant findings. Results were considered significant at p < 0.05. The results of this study show that the novel neck-strengthening device may be an effective mechanism for preventing mild TBIs.

Curcumin alleviates traumatic brain injury induced by gas explosion through modulating gut microbiota and suppressing the LPS/TLR4/MyD88/NF-κB pathway.

Gas explosions (GE) are a prevalent and widespread cause of traumatic brain injury (TBI) in coal miners. However, the impact and mechanism of curcumin on GE-induced TBI in rats remain unclear. In this study, we simulated GE-induced TBI in rats and administered curcumin orally at a dose of 100mg/kg every other day for 7days to modulate the gut microbiota in TBI rats. We employed 16S rRNA sequencing and LC-MS/MS metabolomic analysis to investigate changes in the intestinal flora and its metabolic profile. Additionally, we utilized ELISA, protein assays, and immunohistochemistry to assess neuroinflammatory signaling molecules for validation. In a rat TBI model, GE resulted in weight loss, pathological abnormalities, and cortical hemorrhage. Treatment with curcumin significantly mitigated histological abnormalities and microscopic mitochondrial structural changes in brain tissue. Furthermore, curcumin treatment markedly ameliorated GE-induced brain dysfunction by reducing the levels of several neuroinflammatory signaling molecules, including neuron-specific enolase, interleukin (IL)-1β, IL-6, and cryptothermic protein 3. Notably, curcumin reshaped the gut microbiome by enhancing evenness, richness, and composition. Prevotella_9, Alloprevotella, Bacilli, Lactobacillales, Proteobacteria, and Gammaproteobacteria were identified as prominent members of the gut microbiota, increasing the linear discriminant analysis scores and specifically enhancing the abundance of bacteria involved in the nuclear factor (NF)-κB signaling pathway, such as Lachnospiraceae and Roseburia. Additionally, there were substantial alterations in serum metabolites associated with metabolic NF-κB signaling pathways in the model group. Curcumin administration reduced serum lipopolysaccharide levels and downregulated downstream Toll-like receptor (TLR)4/myeloid differentiation primary response 88 (MyD88)/NF-κB signaling. Furthermore, curcumin alleviated GE-induced TBI in rats by modulating the gut microbiota and its metabolites. Based on these protective effects, curcumin may exert its influence on the gut microbiota and the TLR4/MyD88/NF-κB signaling pathways to ameliorate GE-induced TBI.

Frequency and Outcome of Traumatic Subarachnoid Hemorrhage in patients presenting with Traumatic Brain Injury at Tertiary Care Hospital, Karachi

Aim: To determine the frequency and outcome of traumatic subarachnoid hemorrhage (tSAH) in patients presenting with traumatic brain injury. Method: A cross-sectional study was conducted at the Department of Neurosurgery, JPMC, Karachi from August 2021 to July 2022. Patients presenting with traumatic brain injury at the Department of Neurosurgery, JPMC, Karachi were enrolled in this study. A brief history of demographic information, duration, and mode of head injury was taken at the time of admission. CT scan brain was performed and interpreted.The findings of quantitative and qualitative variables (gender, smoking status, diabetes mellitus (DM) type II, hypertension, associated brain injuries, mode of head injury, tSAH, and good outcome) were recorded in the performance. Results: A total of 267 patients were enrolled in the study. The majority of the patients were aged between 21-48 years. Around 197(73.8%) patients were male and 75(28.1%) were female. The cause of traumatic brain injury was found to be road traffic accidents in 157(58.8%) individuals. The Glasgow coma scale (GCS) at presentation was 3-8 in (33.70%) of patients, 9 -13 in (43.07%) of patients, and 14-15 in (23.22%) of patients. At the time of discharge, GCS was 14-15 in (40.07%), 9-13 in (25.09%) patients, 3-8 in 23.59%, and 11.23% of patients died. It was found that both age (p=0.003), gender (p=0.002), and other brain injuries (p=0.0001) were significantly associated with the outcome. Conclusion: The present study revealed the outcome of traumatic subarachnoid hemorrhage (tSAH) in the majority of the patients was unfavorable. Age, diabetes mellitus, smoking, and other associated brain injuries were significantly related to unfavorable outcomes in the study. Keywords: Traumatic subarachnoid hemorrhage, traumatic brain injury, GCS, neurosurgery

Outcomes and associated factors of traumatic brain injury among adult patients treated in Amhara regional state comprehensive specialized hospitals

BackgroundGlobally, traumatic brain injury is the leading cause of death and disability which affects more than 69 million individuals a year.ObjectiveThis study aimed to assess the outcome and associated factors of traumatic brain injury among adult patients treated in Amhara regional state comprehensive specialized hospitals.MethodInstitutional-based cross-sectional study design was conducted from January 1, 2018, to December 30, 2020. A simple random sampling technique was used and a checklist was used to extract data between March 15 and April 15, 2021. The data were entered into Epi-data version 4.2 and exported to SPSS version 25 for analysis after being checked for consistency. Associated variables with outcomes of traumatic brain injury were determined by a binary logistic regression model. The degree of association was interpreted by using AOR and a 95% confidence interval with a p-value less than or equal to 0.05 at 95% CI was considered statistically significant.ResultIn this study road traffic injury was the most frequent cause of traumatic brain injuries among adult patients, accounting for 181 (37.5%), followed by assault, accounting for 117 (24.2%) which affects adult age groups. One-third of the participant had a moderate Glasgow coma scale of 174(36%). Only 128(26.8%) patients arrived within one hour. One hundred sixty, 160 (33.1%) of patients had a mild traumatic brain injury, whereas, 149(36%) of patients had a severe traumatic brain injury. Regarding computerized tomography scans findings, the hematoma was the most common (n = 163, 33.7%). Ninety-one, 91(18.8%) of participants had cerebrospinal fluid otorrhea, and, 92(19%) were diagnosed with a positive battle sign. The overall prevalence of unfavorable outcomes after traumatic brain injury was found to be 35.2% (95%CI (30.8–39.1). Having additional Injury, hypoxia, time to hospital presentation after 24 h, severe Glasgow Coma Scale, moderate Glasgow Coma Scale, tachypnea, bradypnea, and cerebrospinal fluid Othorrhea, were factors associated with unfavorable outcomes.Conclusion and recommendationIn this study, the overall unfavorable outcome was experienced by about four out of every 10 victims of traumatic brain injury. Time of arrival > 24 h, low Glasgow coma scale, additional injury, Cerebrospinal fluid otorrhea, abnormal respiration, and hypoxia were significant predictors of unfavorable outcomes. To reduce the adverse effects of traumatic brain injury in adults, it is therefore desirable to guarantee safe road traffic flow and improve health care services.

Outcome of 1939 traumatic brain injury patients from road traffic accidents: Findings from specialist medical reports in a low to middle income country (LMIC).

Road traffic accident (RTA) is the major cause of traumatic brain injury (TBI) in developing countries and affects mostly young adult population. This research aimed to describe the factors predicting functional outcome after TBI caused by RTA in a Malaysian setting. This was a retrospective cross-sectional study conducted on specialist medical reports written from 2009 to 2019, involving patients who survived after TBI from RTA. The functional outcome was assessed using the Glasgow Outcome Scale-Extended (GOSE). Factors associated with good outcome were analysed via logistic regression analysis. Multivariate logistic regression analysis was used to derive the best fitting Prediction Model and split-sample cross-validation was performed to develop a prediction model. A total of 1939 reports were evaluated. The mean age of the study participants was 32.4 ± 13.7 years. Most patients were male, less than 40, and with average post RTA of two years. Good outcome (GOSE score 7 & 8) was reported in 30.3% of the patients. Factors significantly affecting functional outcome include age, gender, ethnicity, marital status, education level, severity of brain injury, neurosurgical intervention, ICU admission, presence of inpatient complications, cognitive impairment, post-traumatic headache, post traumatic seizures, presence of significant behavioural issue; and residence post discharge (p<0.05). After adjusting for confounding factors, prediction model identified age less than 40, mild TBI, absence of post traumatic seizure, absence of behaviour issue, absence of cognitive impairment and independent living post TBI as significant predictors of good functional outcome post trauma. Discrimination of the model was acceptable (C-statistic, 0.67; p<0.001, 95% CI: 0.62-0.73). Good functional outcome following TBI due to RTA in this study population is comparable to other low to middle income countries but lower than high income countries. Factors influencing outcome such as seizure, cognitive and behavioural issues, and independent living post injury should be addressed early to achieve favourable long-term outcomes.

Abusive head trauma in infants: An observational single centre study comparing developmental and functional outcome between 18 months and 5 years

BackgroundAbusive head trauma (AHT) is a major cause of traumatic brain injury in infancy. This exploratory study compared standardized developmental assessment versus functional outcome assessment between 18 months and 5 years of age following AHT in infancy. MethodsObservational cross-sectional study after surviving AHT in infancy. Seventeen children between 18 months and 5 years of age underwent clinical examination, developmental assessment using the Schedule of Growing Skills II (SGS II) and functional assessment using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds). Additional clinical information was extracted from medical records. ResultsAge at assessment ranged from 19 to 53 months (median 26 months). Most (n = 14) were delayed in at least 1 domain, even without neurological or visual impairment or visible cortical injury on neuroimaging, including 8 children with favourable GOS-E Peds scores. The most affected domain was hearing and language. Delay in the manipulative domain (n = 6) was associated with visual and/or neurological impairment and greater severity of delay across multiple domains. Eleven (64.7 %) had GOS-E Peds scores indicating good recovery, with positive correlation between GOS-Peds scores and number of domains delayed (r = 0.805, p < 0.05). ConclusionThe SGS-II detects behavioural and cognitive deficits not picked up by the GOS-E Peds. Combining both tools for assessment of AHT survivors under 5 years of age provides a comprehensive profile which addresses multiple domains of development and function, facilitating targeted intervention. Detection of developmental problems in the majority of survivors makes AHT prevention a public health priority.

Head acceleration during impacts on snow: evaluation of a ski helmet

Current standards require ski helmets to meet acceleration criteria during impacts to a rigid surface, but do not require helmets to be evaluated for head impacts to snow, which is a common cause of traumatic brain injury in skiing and snowboarding. The objective of this study is to measure head linear acceleration during impacts to snow, with and without a ski helmet. A portable test bench was developed and used to perform drop test of an instrumented headform onto groomed ski slopes. Impacts were made on the top of the head with and without a helmet, at three speeds (5.3 ​m/s, 6.1 ​m/s, 7.5 ​m/s) and on three types of snow (soft, hard, very hard). Head linear acceleration, HIC, snow hardness, and penetration of the head into the snow were recorded. Statistical analysis was performed using factorial ANOVAs. 96 impacts were performed. The mean peak head linear acceleration was 51G (±6G), 106G (±29G), and 170G (±27G) on soft, hard, and very hard snow, respectively, at 6.1 ​m/s. Head acceleration and HIC exceeded published thresholds for concussion and skull fracture in 85 and 28 impacts respectively. Head linear acceleration significantly increased with impact speed (p ​< ​0.001) and snow stiffness (p ​< ​0.001), but helmet use did not significantly reduce acceleration. The helmeted headform penetrated less into the snow than the non-helmeted headform. Helmet use did not significantly reduce head linear acceleration for the snow conditions tested. The study suggests that head-snow impact characteristics should be considered in the design and evaluation of future helmets.

Retrospective autopsy-based survey of fatal traumatic brain injuries in Benin City, Nigeria

Background: Traumatic brain injury (TBI) is major cause of death in young adults. It results from external force to the head causing injury to the contents of the skull with or without damage to the skull itself.&#x0D; Aims and objectives: To describe the autopsy findings in patients with Traumatic brain injuries.Materials and Methods: A Retrospective Study of findings in patients who suffered Traumatic Brain Injuries as seen at autopsy. The historical and autopsy data of all Traumatic brain injury patients whose bodies were received between 2011 and 2021 were analyzed.&#x0D; Results: TBIs account for 66.7% of traumatic deaths in our institution. Male to female ratio was 1:0.22, and mean age was 39.30±16.65 years. The most common cause of TBI was road traffic accidents (90.9%), with gunshots (5.6%) as a distant second. Intracranial hemorrhages were present in 99.6% of cases and almost all (98.8%) died as a result of Raised Intracranial pressure associated with intracranial hemorrhage. The most common pattern was Subdural hemorrhage (62.65%); followed by Subarachnoid hemorrhage (52.35%); Intraparenchymal hemorrhage (40.88%), Epidural hemorrhage (18.24%); and intraventricular hemorrhage (9.71%). Skull fractures were present in 41.6% of cases. &#x0D; Conclusion: RTA is the most common cause of traumatic brain injury in our study and the leading cause of traumatic deaths. Multiple injuries appears to contribute less to mortality amongst our TBI patients but this may be due to under reporting of injuries found in polytraumatized patients. Morbidity and mortality due to TBI, and trauma in general, will be reduced by improving road safety, and functional protocols for emergency and prehospital care of trauma patients.

Hemophilia and non-accidental head trauma in two siblings: lessons and legal implications.

Non-accidental head trauma (NAHT) is a common cause of traumatic brain injury in childhood, origin of profound and disabling neurological sequalae, and in the most disgraceful cases, ultimately death.Subdural hematoma (SDH) is the most common intracranial finding in NAHT. On the other hand, congenital bleeding disorders are a minor but a significant cause of ICH in the neonate and toddler. Not uncommonly, intracranial bleeding is the first sign of a severe inherited coagulation disorder. In the presence of an unexpected intracranial bleeding after a minor trauma or without a clear history of the related events, physicians and caregivers may be confronted to the dilemma of a possible child abuse. It must be bear in mind that physical abuse and bleeding disorders can co-exist in the same child.We report here the case of two siblings in whom a diagnosis of hemophilia coexisted with the presumption of a non-accidental head trauma. Child abuses were inflicted in both children with a spare time of 2years. A diagnosis of mild hemophilia was prompted in the first sibling after initial NAHT, while inflicted trauma was evident in the second sibling after neuroimaging findings and concomitant lesions. Lessons from this case in co-existing bleeding disorders and inflicted trauma and legal implications derived will be discussed thereafter.The possibility of a bleeding disorder should be considered in all children presenting with unexplained bleeding at a critical site in the setting of suspected physical maltreatment, particularly intracranial hemorrhage (ICH).

A 6 years trends in hospitalization: retrospective study of Traumatic Brain Injury

Abstract Introduction Traumatic Brain Injury (TBI) is a significant public health issue globally, and the mortality and morbidity burden is particularly high in low- and middle-income counties (LMICs). The WHO predicts a disproportionately large increase of TBI burden in LMICs. The aim of this study was to identify trends in hospitalization associated with TBI in Georgia from 2015-2020. Methods The study was designed in the framework of the project INITIatE: International Collaboration to Increase TBI Surveillance in Europe, funded by the US National Institutes of Health (NIH/NINDS R21NS098850). The surveillance database of National Center for Disease Control and Public Health of Georgia was used for the study. Results During the study period a total 51 147 patients were admitted in hospitals throughout the country. In 2015-2019 the hospitalization increased and highest number of cases was in 2019 (n = 11779; 23,0%), in 2020 hospitalization decreased in comparison with the previous year (n = 9228; 18,0%). The highest number of burn injuries (n = 22963; 45,0%) occurred in the capital of Georgia (Tbilisi). Among hospitalized patients about 61,0% were males (n = 31162) and 39,0% females (n = 19985), retrospectively with ratio 1,6:1. The modal age of hospitalized patients was 25-44 and the highest hospitalization was in the age group of 15-24. 92,5% of cases were unintentional. The leading cause of Traumatic Brain Injury in all years were falls with some variations (57%-71%), followed by road traffic injuries (12%-25%). The average of LOS was 3 days, the highest LOS was 702 days. 1,6% (n = 805) of patients died. The most common mechanism of fatal injuries were falls. Conclusions The study provide important information about trends in hospitalization, size of the TBI problem, which is crucial for elaborating relevant policy and establishing priorities in order to reduce the burden of Traumatic Brain Injury in Georgia, as well to identify directions for further TBI related research. Key messages • Epidemiological data are essential for designing relevant preventive programs. • Prevention is a key component of public health efforts to reduce TBI burden.

Features of lipid metabolism in membranes of rat cells at experimental traumatic brain injury on the background of chronic alcohol intoxication

Introduction. Alcohol intoxication is often the cause of traumatic brain injury. The purpose of the work was to study the features of lipid metabolism in erythrocytes and mitochondria of the cerebral cortex cell membranes of rats in traumatic brain injury on the background of chronic alcohol intoxication. Materials and methods. The studies were carried out on 140 male rats of the Wistar line weighing 170-250 g. Chronic alcohol intoxication was caused by using 15% ethanol as the only source of fluid for 20 days. Reproduction of traumatic brain injury was carried out by a shock model. Statistical analysis of data was conducted by using „Primer Biostatistics 6.0”. The criteria of parametric statistics were used. The level of p &lt;0.05 was statistically significant. Results. Chronic alcohol intoxication in rats and inducing of traumatic brain injury separately causes a significant change of total phospholipids and cholesterol content, and their molar ratio in the membranes of erythrocytes and mitochondria of the cerebral cortex. Particularly pronounced were the changes in studied objects with combined pathology, meaning, traumatic brain injury on the background of chronic alcohol intoxication. Discoordination of lipid metabolism was unidirectional, manifested in a significant reduction in the content of total phospholipids, and increased total cholesterol, which led to a violation of the molar ratio of total cholesterol/phospholipids in the direction of increasing the coefficient, which is normally about 1.0. In subsequent monitoring periods, there was a gradual restoration of individual fractions of phospholipids, but on the 30th day of the study, it did not reach the control values. That means that discoordination of the metabolism of individual phospholipid fractions was so pronounced, that even on 30th day of arbitrary reproduction did not reach the initial values, which again emphasizes the severity of the morphofunctional state of red blood cells membranes’ disturbance. Conclusions. The revealed features of lipid metabolism in the membranes of erythrocytes and mitochondria of the cerebral cortex in traumatic brain injury on the background of chronic alcohol intoxication are an important component for understanding the ongoing pathophysiological processes and searching for new effective drugs with targeted action.

Decompressive Craniectomy and Shunt-Amenable Post-Traumatic Hydrocephalus: A Single-Center Experience

BackgroundPrior studies have shown that decompressive craniectomy may be an independent risk factor for the development of post-traumatic hydrocephalus (PTH). It is upon this background that we chose to conduct our single-center retrospective study to establish the possibility of an association between decompressive craniectomy and PTH.MethodsA retrospective review involving a database of all patients with traumatic brain injury was undertaken. All referrals and admissions with traumatic brain injury, as defined by the Mayo Classification, from January 2012 to May 2022, were included in the subsequent analysis. Statistical analysis was carried out using IBM SPSS version 28.0.1.ResultsThe mean age of the cohort was 44.91 ± 19.16 with more males (82.3%) than females (17.7%). Vehicle incident/collision was the most common cause of traumatic brain injury. 84% of the cohort was alive at 30 days, 4% were noted to have an intracranial infection, and 3% underwent shunt insertion procedures, while 14% received decompressive craniotomies as part of their clinical management. There was a statistically significant association between undergoing decompressive craniectomy, and the development of PTH (odds ratio, 4.759 [95% confidence interval, 1.290–17.559]; P = 0.019). The presence of intracranial infection and insertion of an external ventricular drain insertion were also independent predictors of developing PTH.ConclusionsThis study adds to the growing body of work regarding the immediate and long-term effects of the procedure. Although life-saving, PTH, needing shunt insertion, is one of the possible complications that surgeons and patients should be aware of.

PkCOs: Synchronization of Packet-Coupled Oscillators in Blast Wave Monitoring Networks

Blast waves with a large amount of energy, from the use of explosive weapons, is a major cause of traumatic brain injury in armed and security forces. The monitoring of blast waves is required for defence and civil applications. The utilization of wireless sensing technology to monitor blast waves has shown great advantages, such as easy deployment and flexibility. However, due to drifting embedded clock frequency, the establishment of a common timescale among distributed blast monitoring sensors has been a challenge, which may lead to a network failing to estimate the precise acoustic source location. This work adopts a packet-coupled oscillators (PkCOs) protocol to synchronize drifting clocks in a wireless blast wave monitoring network. In order to address packet collisions caused by the concurrent transmission, an anti-phase synchronization solution is utilized to maintain clock synchronization, and the corresponding superframe structure is developed to allow the hybrid transmission of the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Sync</i> packet and the blast wave monitoring data. As a network scales up and the hop distance grows, the packet exchange lag increases during a superframe. This, along with the drifting clock frequency, leads to the degradation of synchronization performance while the clock frequency is usually assumed to be zero and nondrifting. Thus, a compensation strategy is proposed to eliminate the joint impacts and to improve synchronization precision. The theoretical performance analysis of the PkCOs algorithm in the network is presented along with verification by simulation means. Finally, the performance of the PkCOs synchronization protocol is evaluated on an IEEE 802.15.4 hardware testbed. The experimental results show that the PkCOs algorithm provides an alternative clock synchronization solution for blast wave monitoring networks.

Marshall Computed Tomography Scoring System in Predicting Early Mortality in Patients with Traumatic Brain Injury.

Traumatic brain injury is common neurological emergency worldwide associated with high rates of morbidity and mortality. Marshall scoring system is one of the several scoring systems that uses initial computed tomography findings to predict outcome. This study aims to determine the role of Marshall scoring system in predicting early mortality in patients with Traumatic brain injury in Nepalese patient population. Patients admitted with diagnosis of Traumatic brain injury between August 2017 and July 2018 in our institution were studied prospectively. Clinical status of patient was noted and computed tomography scan of head was interpreted according to Marshall scoring system. Patients were monitored during the hospital stay and in-hospital mortality was correlated with different components of Marshall scoring system at discharge. The most common cause of Traumatic brain injury was road traffic accident (45%). Severe Traumatic brain injury was noted in 17% of patients and commonest intracranial mass lesion was contusion (24%). Surgery was performed in 29% of patients. There was significant correlation between increase in Marshall score and mortality (p<0.001). Degree of midline shift (p<0.016), status of basal cisterns (p<0.001), and combination of mass lesions (p=0.005) were independent predictors of early mortality. Marshall scoring is highly reliable scoring system to predict early mortality in patients with Traumatic brain injury. Degree of midline shift, status of basal cisterns, and combination of mass lesions are independent parameters predicting early mortality in patients with traumatic brain injury.

Pattern and Outcome of Traumatic Brain Injury, Addis Ababa, Ethiopia: A Cross-sectional Hospital-based Study.

Traumatic brain injury (TBI) is the leading cause of death and disability in young adults in the world. This study assessed clinical characteristics and in-hospital outcomes among traumatic brain injury patients presenting to Addis Ababa Burn, Emergency, and Trauma hospital. A cross-sectional hospital-based survey was conducted at AaBET hospital from January 01/2020 to April 30/2020. Data were collected using structured questionnaires from the trauma registry and patient chart. The collected data were analyzed using statistical software SPSS v 25.0. Among the 304 traumatic brain injury patients, 75% were males with a mean age of 30.4 + 15.7, and 59.2% came from the Oromia region. Road traffic injury was responsible for 45% of the cases, of which pedestrian struck accounts for 52.2% of the cases. Only 50 (16.4%) patients arrived below 02 hours. 201 (66.1%) patients had mild traumatic brain injury the rest had moderate to severe traumatic brain injury. Skullbone fracture (linear, DSF, & BSF) was the most common (n=157, 63.1%) followed by intracerebral lesions (DAI, brain contusion, & ICH) (n=140, 56.5%). Forty-three (14.1%) patients were intubated. 45(14.8%) cases had a neurosurgical intervention. The mortality rate of severe, moderate, & mild TBI were 25%, 8.0% & 2.0% respectively with an overall mortality of 5.6%. This study showed road traffic injury was the commonest cause of traumatic brain injury which affected young age groups. There was a delayed presentation to AaBET hospital Emergency. The mortality rate was lower than other Ethiopian hospital studies.

The relationship between road traffic collision dynamics and traumatic brain injury pathology.

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.

Trends and external causes of traumatic brain injury and spinal cord injury mortality in south China, 2014\u20132018: an ecological study

BackgroundThe epidemiological evidence of traumatic brain injury (TBI) and spinal cord injury (SCI) mortality in mainland China is lacking. We aimed to assess the trends of TBI and SCI mortality, and their association with sex, age, location and external causes of injury in south China.MethodsMortality data were derived from the Disease Surveillance Points (DSPs) system of Guangdong province between 2014 and 2018. We examined the trends in mortality with Cochran–Armitage trend test, and the association between the socio-demographic factors and the TBI and SCI mortality by using negative binomial models. Subgroup analysis was performed by stratifying the external causes of TBI and SCI.ResultsThe age-standardized TBI mortality remained relatively stable (from 11.6 to 15.4 per 100,000), while the SCI mortality increased by 148.3% from 2014 to 2018. Compared with females and urban residents, the adjusted mortality rate ratios of males and rural residents were 2.3 and 2.0 for TBI, and 2.2 and 4.6 for SCI, respectively. TBI and SCI mortality increased substantially with age. Motor vehicle crashes and falls were the leading causes of TBI mortality in residents aged under 75 years and over 75 years, respectively. Falls were the most important external cause for SCI death of all ages.ConclusionsBeing male, rural and elderly residents are at higher risk of dying from TBI and SCI. The substantial burden of TBI and SCI caused by road traffic crashes and falls has called for the urgent need to improve injury prevention, pre-hospital aid, hospital treatment and recovery.

The Prevalence of Risky Behaviours in Traffic that can Lead to Traumatic Brain

Introduction: Traffic accidents are a common cause of traumatic brain injuries. Such injuries are often associated with problematic behaviour i.e., violations of the Traffic Safety Act. Driving under the influence of intoxicants and non-compliance with traffic signals often cause traffic accidents, and not wearing a crash helmet or not wearing a protective seat belt increase the possibility of developing a traumatic brain injury. Objective: The aim of this study is to examine the prevalence of risky behaviours in traffic that can lead to traumatic brain injury and to examine differences according to gender. It is assumed that the most common risky behaviour is failure to wear a crash helmet and that the male participants will show a higher prevalence of risky behaviour compared to women. Methods: The measuring instrument is a questionnaire consisting of nine statements. The questionnaire was filled out by a sample of 302 people in Croatia. The IBM SPSS Statistics 22 program was used for data processing. The prevalence of risky behaviours was expressed in percentages, and the Pearson’s Chi-Square was used to examine the differences between male and female participants. Results: The results show that risky behaviours in traffic are present, especially not wearing a crash helmet while riding a bicycle, running across the road on a red light, and not wearing a seat belt in a car whilst sitting in the back seat. The male participants showed a higher prevalence of risky behaviour compared to women. Conclusion: To reduce the number of traffic accidents that can lead to traumatic brain injury, it is important to act on risky behaviours in traffic. Public health policies and legislation are one way of prevention. In addition, it is important to inform, educate and raise public awareness about this global problem. In order to implement the necessary preventative measures, one should be aware of the prevalence of the risky behaviours in traffic that can lead to traumatic brain injury and of the groups that are more willing to take risks in traffic.

PIT2 Acute Care Costs of Pediatric Sports-Related Head Injuries in Australia: The Australasian Paediatric Head Injury Study (APHIRST)

Sports activities are a common cause of traumatic brain injury (TBI) in children. Annual costs of hospitalization for all sports-related injuries for children aged ≤16 years in Australia are approximately AU $40 million. We aimed to compare emergency department (ED) and hospital acute care costs for children with head injuries due to sports activities in Australia. This was a cost analysis of a multi-center prospective observational study of 17,841 children <18 years-old with head trauma. Sports-related head injuries were identified using the ICD-10-AM activity codes U50-U71. We stratified participants into two age-groups (younger: 5 to <12 years) and (older: 12 to <18 years). Taking a public-sector healthcare perspective, we applied costs from a single pediatric site to patient-level data and estimated acute care costs for ED visits and hospital admissions. All costs were inflated to 2018 Australian dollars ($). Total acute care costs for 2,812 children with sports-related head injuries were $2.7 million, and the average cost per episode was $954 (95%CI $832-$1,084). The younger age-group accounted for 44% of children and 38% of acute care costs ($1.0 million). Bicycle riding was the most common mechanism of head injury in the younger age-group and had the highest total acute care costs ($355,000), with an average cost per episode of $1,522 (95%CI $1,036-$2,008). Rugby was the most common head injury mechanism in older children, accounting for 10% of the cohort, 7.2% of total acute care costs ($192,000), and had an average cost of $682 (95% CI $564-$801). In the older age-group, skateboarding had the highest acute care costs ($430,000), with the average cost per episode of $3,797 (95% CI $1,082-$6,512). Sports-related trauma accounts for approximately 15% of pediatric head injuries and associated acute care costs in Australia. Injury prevention strategies should focus on targeted age-related mechanisms to reduce TBI in children.