Incidence Of Traumatic Brain Injury Research Articles

An international, prospective observational study on traumatic brain injury epidemiology study protocol: GEO-TBI: Incidence

Background The epidemiology of traumatic brain injury (TBI) is unclear – it is estimated to affect 27–69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and epidemiology of TBI remains unclear. To address this need, we established the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry, enabling recording of all TBI cases requiring admission irrespective of surgical treatment. Objective The GEO-TBI: Incidence study aims to describe TBI epidemiology and outcomes according to development indices, and to highlight best practices to facilitate further comparative research. Design Multi-centre, international, registry-based, prospective cohort study. Subjects Any unit managing TBI and participating in the GEO-TBI registry will be eligible to join the study. Each unit will select a 90-day study period. All TBI patients meeting the registry inclusion criteria (neurosurgical/ICU admission or neurosurgical operation) during the selected study period will be included in the GEO-TBI: Incidence. Methods All units will form a study team, that will gain local approval, identify eligible patients and input data. Data will be collected via the secure registry platform and validated after collection. Identifiers may be collected if required for local utility in accordance with the GEO-TBI protocol. Data Data related to initial presentation, interventions and short-term outcomes will be collected in line with the GEO-TBI core dataset, developed following consensus from an iterative survey and feedback process. Patient demographics, injury details, timing and nature of interventions and post-injury care will be collected alongside associated complications. The primary outcome measures for the study will be the Glasgow Outcome at Discharge Scale (GODS) and 14-day mortality. Secondary outcome measures will be mortality and extended Glasgow Outcome Scale (GOSE) at the most recent follow-up timepoint.

Traumatic brain injury incidence and mortality: a large population-based study.

Traumatic brain injury (TBI) is a severe condition that represents a major global public health concern. Provide a comprehensive epidemiological outlook encompassing TBI incidence, healthcare provision and mortality. 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. 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. 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.

The recent two decades of traumatic brain injury: a bibliometric analysis and systematic review.

Traumatic brain injury (TBI) is a serious public health burden worldwide, with a mortality rate of 20%-30%; however, reducing the incidence and mortality rates of TBI remains a major challenge. This study provides a multidimensional analysis to explore the potential breakthroughs in TBI over the past two decades. We used bibliometric and Latent Dirichlet Allocation (LDA) analyses to analyze publications focusing on TBI published between 2003 and 2022 from the Web of Science Core Collection (WOSCC) database to identify core journals and collaborations among countries/regions, institutions, authors, and research trends. Over the past 20 years, 41,545 articles on TBI from 3,043 journals were included, with 12,916 authors from 20,449 institutions across 145 countries/regions. The annual number of publications has increased ten-fold compared to previous publications. This study revealed that high-income countries, especially the United States, have a significant influence. Collaboration was limited to several countries/regions. The LDA results indicated that the hotspots included four main areas: "Clinical finding", "Molecular mechanism", "Epidemiology", and "Prognosis". Epidemiological research has consistently increased in recent years. Through epidemiological topic analysis, the main etiology of TBI has shifted from traffic accidents to falls in a demographically aging society. Over the past two decades, TBI research has developed rapidly, and its epidemiology has received increasing attention. Reducing the incidence of TBI from a preventive perspective is emerging as a trend to alleviate the future social burden; therefore, epidemiological research might bring breakthroughs in TBI.

Risk factors for clinically important traumatic brain injury in minor head injury in older people

Background and objectivesThe incidence of traumatic brain injury (TBI) in older individuals is increasing with an increase in the older population. For older people, the required medical interventions and hospitalization following minor head injury have negative impacts, which have not been reported in literature up till now. We aimed to investigate the risk factors for clinically important traumatic brain injury (ciTBI) in older patients with minor head injury. MethodsThis is a retrospective single-center cohort study. Older patients aged ≥65 years presenting with head injury and a Glasgow Coma Scale (GCS) score of ≥13 upon arrival at the hospital between January 1, 2018, and October 31, 2021, were included. Patients with an injury duration of ≥24 h were excluded. The primary outcome was defined as ciTBI (including death, surgery, intubation, medical interventions, and hospital stays of ≥2 nights). Multiple logistic regression analysis was conducted to identify the risk factors. ResultsA total of 296 patients were included initially, and 6 of them were excluded subsequently. ciTBI was identified in 62 cases. According to the results of the multiple logistic regression analysis, GCS scores of ≤14 (OR 3.72, 95% CI 1.89–7.30), high-risk mechanisms of injury (OR 2.80, 95% CI 1.39–5.64), vomiting (OR 5.01, 95% CI 1.19–21.1), and retrograde amnesia (OR 6.90, 95% CI 3.37–14.1) were identified as risk factors. ConclusionIn older patients with minor head injury, GCS ≤14, high-risk mechanisms of injury, vomiting, and retrograde amnesia are risk factors for ciTBI.

258 Impact of Risk Stratified Antithrombotic Medication Resumption After Traumatic Brain Injury on Patient Outcomes

INTRODUCTION: The incidence of traumatic brain injury (TBI) in patients on antithrombotic (AT) medications to prevent thromboembolic events is increasing. AT medications include antiplatelets and/or anticoagulants. While these medications are generally stopped in the setting of intracranial bleed, the optimal medication resumption time is uncertain. Both brief and prolonged suspension carry risk. In March 2021 we adjusted our institutional guidelines from restarting AT therapy at two weeks or more after TBI to resuming medications based on patient risk factors. METHODS: We performed a retrospective case-control study of data from the University of Cincinnati Level 1 Trauma Center neurotrauma registry between February 2017-November 2022. Patients on AT therapy presenting with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13-15 were included. The LR cohort included patients from February 2017-December 2019. The RSR cohort included patients from March 2021-November 2022. Demographics, injury variables, medication history, medication resumption, and thrombotic or hemorrhagic events up to 6 months after injury were collected. Groups were compared using t-tests for linear variables and Chi-Square for categorical variables with p < 0.05 denoted as significant. RESULTS: We identified 406 patients with 337 patients in the LR cohort and 69 patients in the RSR cohort. Early resumption (during hospitalization) occurred in 21.7% of the RSR cohort compared to 9.5% in the LR group. The difference in occurrence of thrombotic and hemorrhagic events between groups was not significant. CONCLUSIONS: Resuming antithrombotic medications after a TBI based on risk stratification criteria allows earlier resumption of medication with no associated increase in thrombotic or hemorrhagic events.

Impact of menopause-associated frailty on traumatic brain injury

Navigating menopause involves traversing a complex terrain of hormonal changes that extend far beyond reproductive consequences. Menopausal transition is characterized by a decrease in estradiol-17β (E2), and the impact of menopause resonates not only in the reproductive system but also through the central nervous system, musculoskeletal, and gastrointestinal domains. As women undergo menopausal transition, they become more susceptible to frailty, amplifying the risk and severity of injuries, including traumatic brain injury (TBI). Menopause triggers a cascade of changes leading to a decline in muscle mass, accompanied by diminished tone and excitability, thereby restricting the availability of irisin, a crucial hormone derived from muscles. Concurrently, bone mass undergoes reduction, culminating in the onset of osteoporosis and altering the dynamics of osteocalcin, a hormone originating from bones. The diminishing levels of E2 during menopause extend their influence on the gut microbiota, resulting in a reduction in the availability of tyrosine, tryptophan, and serotonin metabolites, affecting neurotransmitter synthesis and function. Understanding the interplay between menopause, frailty, E2 decline, and the intricate metabolisms of bone, gut, and muscle is imperative when unraveling the nuances of TBI after menopause. The current review underscores the significance of accounting for menopause-associated frailty in the incidence and consequences of TBI. The review also explores potential mechanisms to enhance gut, bone, and muscle health in menopausal women, aiming to mitigate frailty and improve TBI outcomes.

Evaluating a 14-week neck strengthening protocol for neuromuscular indicators associated with head and neck trauma

Increased neck strength has been linked to a potential decrease in traumatic brain injuries (TBI). The purpose was to determine the efficacy of a neck-strengthening protocol using a novel neck-strengthening device to increase isometric neck strength and rate of force development (RFD). Utilizing self-generated centripetal force, participants trained for 14 weeks. A linear mixed model was used to analyze the relationship between post-assessment measurements and pre-assessments measurements, while accounting for repeated measure random effect at the individual level, and a regular random error term. RFD values were 4.344 times higher in the clockwise direction and 5.978 times higher in the counterclockwise direction when comparing pre and post assessment measurements. Isometric neck strength increased significantly (p < 0.05) in the cervical extension (p = 0.010) and left lateral flexion (p = 0.009) directions. The results can be used in strength training and clinical settings to potentially reduce the incidence of TBI.

Outcome of patients with traumatic cranial nerve palsy admitted to a university hospital in Nepal

BackgroundCranial nerve palsy (CNP) is a common complication of traumatic brain injury (TBI). Despite a high incidence of TBI in Nepal (382 per 100,000), literature on the specific management and outcome of CNP is lacking. This study aimed to examine the outcomes of TBI patients involving single versus multiple CNP.MethodsA retrospective chart review of 170 consecutive TBI patients admitted to the tertiary neurosurgical center in Nepal between April 2020 and April 2022 was conducted. Demographic, clinical, and etiological characteristics; imaging findings; and management strategies were recorded, compared, and analyzed using descriptive statistics. The Glasgow Outcome Scale Extended (GOSE) was used to measure the outcomes in two groups of patients (single and multiple CNP) at 3 months.ResultsOut of 250 eligible patients, 80 were excluded and CNP was noted in 29 (17.1%) of the remaining 170. The median age was 34.9 years, and falls (60.6%) were the most common cause of trauma. TBI severity was categorized based on GCS: mild (82.4%), moderate (15.9%), and severe (1.8%). Cranial nerve involvement was seen in 29 (17.05%) patients: single cranial nerve involvement in 26 (89.65%) and multiple nerve involvement in 3 (10.34%). The most common isolated cranial nerve involved was the oculomotor nerve (37.9%). CT findings revealed a maximum of skull fractures with no significant association between CNP and CT findings.ConclusionsCNP is a common consequence of TBI with the most common etiology being falls followed by RTA. Single CNP was more common than multiple CNP with no significant difference in the outcome in the 3-month GOSE score. Further research is needed to determine the burden of traumatic CNP and establish specific management guidelines for different types of CNP.

THE EFFECT OF GABA-BENZODIAZEPINE RECEPTOR COMPLEX MODULATORS (MPTD-01 AND BS 34-20) ON THE CEREBRAL CORTEX AFTER EXPERIMENTAL BRAIN INJURY

Background. Traumatic brain injury (TBI) is a major medical, social, and public health problem, In the military population the TBI incidence also remains high due to blunt head trauma and blast injuries. Considering the substantial TBI burden on society, including possible postraumatic epilepsy onset and other comorbidities the search for new treatment methods, including drug design with the identification of new molecules, is highly relevant.&#x0D; Aim: The study aimed to evaluate the effect of GABA-benzodiazepine receptor complex modulators (hydrogenated 2,3-benzodiazepines MPTD-01 та BS 34-20) on rat cerebral cortex after traumatic brain injury&#x0D; Materials and methods. The experiment was carried out on male Wistar rats. To obtain traumatic brain injury we used the weight drop model. Based on the received treatment, the Rats were divided into intact, placebo (II), and MPTD-01 (III) and BS 34-20 (IV) groups. The cerebral cortex in the impact zone was harvested for examination. The light microscopy was performed on 3, 7, 14, and 21 days after injury.&#x0D; Results. The observed histological picture of the changes in the cerebral cortex, especially in the II group is similar to those, described by other research papers as mild- to severe traumatic brain injury. The reproduction of the blunt trauma model leads to a series of typical changes that replace each other and can be characterized as alteration, edema, phase of cellular reactions, and repair. Unlike the placebo group, the III and IV experimental groups (GABA-benzodiazepine receptor complex modulators administration) cerebral cortex demonstrated a smoothing of the swelling phase and its reduction, a shift in the time phase of cellular reactions to a later time. In the BS 34-20 group, minimal edema was observed on the 21st day of the experiment.&#x0D; Conclusion. Such morphological changes can be considered a neuroprotective effect, however, to fully characterize the effects of the GABA-benzodiazepine receptor complex modulators, glial reactions and neuron-glial interactions should be investigated.

A Novel Experimental Approach for the Measurement of Vibration-Induced Changes in the Rheological Properties of Ex Vivo Ovine Brain Tissue.

Increased incidence of traumatic brain injury (TBI) imposes a growing need to understand the pathology of brain trauma. A correlation between the incidence of multiple brain traumas and rates of behavioural and cognitive deficiencies has been identified amongst people that experienced multiple TBI events. Mechanically, repetitive TBIs may affect brain tissue in a similar way to cyclic loading. Hence, the potential susceptibility of brain tissue to mechanical fatigue is of interest. Although temporal changes in ovine brain tissue viscoelasticity and biological fatigue of other tissues such as tendons and arteries have been investigated, no methodology currently exists to cyclically load ex vivo brain tissue. A novel rheology-based approach found a consistent, initial stiffening response of the brain tissue before a notable softening when subjected to a subsequential cyclic rotational shear. History dependence of the mechanical properties of brain tissue indicates susceptibility to mechanical fatigue. Results from this investigation increase understanding of the fatigue properties of brain tissue and could be used to strengthen therapy and prevention of TBI, or computational models of repetitive head injuries.

Refinement of a Preliminary Case Definition for Use in Traumatic Brain Injury Surveillance.

Current methods used to measure incidence of traumatic brain injury (TBI) underestimate its true public health burden. The use of self-report surveys may be an approach to improve these estimates. An important step in public health surveillance is to define a public health problem using a case definition. The purpose of this article is to outline the process that the Centers for Disease Control and Prevention undertook to refine a TBI case definition to be used in surveillance using a self-report survey. Survey. A total of 10 030 adults participated via a random digit-dial telephone survey from September 2018 to September 2019. Respondents were asked whether they had sustained a hit to the head in the preceding 12 months and whether they experienced a series of 12 signs and symptoms as a result of this injury. Head injuries with 1 or more signs/symptoms reported were initially categorized into a 3-tiered TBI case definition (probable TBI, possible TBI, and delayed possible TBI), corresponding to the level of certainty that a TBI occurred. Placement in a tier was compared with a range of severity measures (whether medical evaluation was sought, time to symptom resolution, self-rated social and work functioning); case definition tiers were then modified in a stepwise fashion to maximize differences in severity between tiers. There were statistically significant differences in the severity measure between cases in the probable and possible TBI tiers but not between other tiers. Timing of symptom onset did not meaningfully differentiate between cases on severity measures; therefore, the delayed possible tier was eliminated, resulting in 2 tiers: probable and possible TBI. The 2-tiered TBI case definition that was derived from this analysis can be used in future surveillance efforts to differentiate cases by certainty and from noncases for the purpose of reporting TBI prevalence and incidence estimates. The refined case definition can help researchers increase the confidence they have in reporting survey respondents' self-reported TBIs as well as provide them with the flexibility to report an expansive (probable + possible TBI) or more conservative (probable TBI only) estimate of TBI prevalence.

Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury: a retrospective comparison of two Dutch level-I trauma centers.

With an increasingly older population and rise in incidence of traumatic brain injury (TBI), end-of-life decisions have become frequent. This study investigated the rate of withdrawal of life sustaining treatment (WLST) and compared treatment outcomes in patients with isolated TBI in two Dutch level-I trauma centers. From 2011 to 2016, a retrospective cohort study of patients aged ≥ 18years with isolated moderate-to-severe TBI (Abbreviated Injury Scale (AIS) head ≥ 3) was conducted at the University Medical Center Rotterdam (UMC-R) and the University Medical Center Utrecht (UMC-U). Demographics, radiologic injury characteristics, clinical outcomes, and functional outcomes at 3-6months post-discharge were collected. The study population included 596 patients (UMC-R: n = 326; UMC-U: n = 270). There were no statistical differences in age, gender, mechanism of injury, and radiologic parameters between both institutes. UMC-R patients had a higher AIShead (UMC-R: 5 [4-5] vs. UMC-U: 4 [4-5], p < 0.001). There was no difference in the prehospital Glasgow Coma Scale (GCS). However, UMC-R patients had lower GCSs in the Emergency Department and used more prehospital sedation. Total in-hospital mortality was 29% (n = 170), of which 71% (n = 123) occurred after WLST. Two percent (n = 10) remained in unresponsive wakefulness syndrome (UWS) state during follow-up. This study demonstrated a high WLST rate among deceased patients with isolated TBI. Demographics and outcomes were similar for both centers even though AIShead was significantly higher in UMC-R patients. Possibly, prehospital sedation might have influenced AIS coding. Few patients persisted in UWS. Further research is needed on WLST patients in a broader spectrum of ethics, culture, and complex medical profiles, as it is a growing practice in modern critical care. Level III, retrospective cohort study.

The Frequency of Neuropsychiatric Sequelae After Traumatic Brain In-jury in the Global South

Countries in the 'global south' are characterized by factors that contribute to the increased incidence of traumatic brain injury (TBI). This systematic review and meta-analysis aimed to assess the prevalence of neuropsychiatric sequelae following a TBI, specifically among the Western Asian, South Asian, and African regions of the global south. A literature review was conducted until August 20, 2021, for publications that measured psychiatric or cognitive impairment after TBI from the 83 countries that constitute the aforementioned regions. The main databases, such as PsycINFO, Scopus, PubMed/MEDLINE, ProQuest (English), Al-Manhal (Arabic) and Google Scholar, were selected for grey literature. Following the evaluation of the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, posttraumatic stress disorders (PTSD), sleep disturbance related to TBI (TBI-SD), obsessive–compulsive disorder (OCD), and cognitive impairment. Of 56 non-duplicated studies identified by the initial search, 27 studies were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in a total sample of 1882 was 35·35% (95% CI=24·64–46·87%), of anxiety in a total sample of 1211 was 28·64% (95% CI=17·99–40·65%), of PTSD in a total sample of 426 was 19·94% (95% CI=2·35–46·37%), of OCD in a total sample of 313 was 19·48% (95% CI=0·23–58·06%), of TBI–SD in a total sample of 562 was 26·67% (95% CI=15·63–39·44%), and cognitive impairment in a total sample of 941 was 49·10% (95% CI=31·26–67·07%). To date, this is the first critical review that has examined the spectrum of post–TBI neuropsychiatric sequelae in the specified regions. While existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.&#x0D; Keywords: traumatic brain injury; neuropsychiatric sequelae; global south; systematic review; meta-analysis; cognitive impairment; anxiety; depression

Classification and Characterization of Traumatic Brain Injuries in the Northern Region of Sweden.

Traumatic brain injury (TBI) is a common cause of death and disability, the incidence of which in northern Sweden is not fully investigated. This study classifies and characterize epidemiological and demographic features of TBIs in a defined population in Umeå county, Sweden. Specifically, to evaluate frequencies of (1) intracranial lesions detected with computed tomography (CT), (2) need for emergency intervention, and (3) hospital admission, in minimal, mild, moderate, and severe TBI, respectively. The data were gathered from 4057 TBI patients visiting our emergency room (ER) during a two-year period (2015-2016), of whom 56% were men and approximately 95% had minimal TBIs (Glasgow Coma Scale (GCS), score 15). Of all injuries, 97.8% were mild (GCS 14-15), 1.7% were moderate (GCS 9-13), and 0.5% were severe (GCS < 9). CT scans were performed on 46% of the patients, with 28% being hospitalized. A high annual TBI incidence of 1350 cases per 100,000 citizens was found. The mortality rate was 0.5% with the majority as expected in the elderly group (>80 years). Minimal TBIs were not as mild as previously reported, with a relatively high frequency of abnormal CT findings and a high mortality rate. No emergency intervention was required in patients in the GCS 13-15 group with normal CT scans. These findings have implications for clinical practice in the ER with the suggestion to include biomarkers to reduce unnecessary CT scans.

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 &lt; 0.05. The results of this study show that the novel neck-strengthening device may be an effective mechanism for preventing mild TBIs.

The Bidirectional Association of TBI and Dementia/MCI among older US Veterans

AbstractBackgroundPrior studies have reported a link between traumatic brain injury (TBI) and risk of adverse neuropsychiatric outcomes including dementia. However it is unclear how prevalent these conditions are prior to TBI and if they are predisposing factors in addition to sequalae.MethodsWe studied older (age &gt;55 years) US veterans who were followed for care at Veterans Affairs Medical Centers across the nation from 2000 to 2019. We first identified all veterans with an incident TBI diagnoses defined as no prior TBI diagnosis, having been seen in an emergency department (ED), having a brain imaging scan (primarily CT) within one day of ED visit and with a subsequent new TBI diagnosis in the electronic medical record (EMR). We then determined 2‐year age‐adjusted prevalence rates (rate per 1000 person‐years and 95% confidence interval or CI) for dementia and mild cognitive impairment (MCI) prior to and post incident TBI. We also compared prior TBI prevalence to prevalence among 1:3 matched (on age and index date) veterans without TBI.ResultsThere were 13,709 primarily male veterans with incident TBI with mean age of 77.7 sd 9.1 years, 81% were non‐Hispanic White. Compared to the 41,127 veterans without TBI (mean age = 77.9, sd 9.1), veterans prior to having an incident TBI had almost a six‐fold greater pre‐TBI age‐adjusted prevalence of dementia (104.9; 95% CI 100.8‐109.0 vs 18.6; 95% CI 17.6‐19.7, p&lt;0.001) and MCI (48.0; 95% CI 45.2‐50.7 vs 8.1; 95% CI 7.4‐8.8, p&lt;0.001). After the incident TBI diagnosis, the age‐adjusted prevalence rates were even higher: dementia (193.5; 95% CI 187.7‐199.2) and MCI (59.3; 95% CI 56.0‐62.6).ConclusionsAmong older US veterans, there is a bidirectional association with dementia/ MCI and TBI with very high prevalence prior to TBI (compared to those without TBI) and even greater prevalence after TBI. These findings highlight the importance of prevention strategies for both pre‐ and post‐TBI cognitive impairment.

Causes of fatal traumatic brain injury in Finland.

The phenotype of patients who suffer fatal traumatic brain injury (TBI) is poorly characterized. The authors examined the external causes, contributing diseases, and preinjury medication in adult patients with fatal TBI in a nationwide Finnish cohort. Deaths caused by TBIs in Finland were examined among decedents aged ≥ 16 years during 2005-2020 from the national Cause of Death Registry. Usage of prescription medications prior to TBI was studied using medication purchase data from the Social Insurance Institution of Finland. The cohort consisted of 71,488,347 person-years, 821,259 total deaths, and 14,630 TBI-related deaths during 2005-2020, of which 67% (n = 9792) occurred in men. Women were older than men among those who suffered TBI-related death (mean age 77.2 ± 17.1 vs 64.5 ± 19.5 years, p < 0.0001). The overall crude incidence rate of fatal TBIs was 20.5/100,000 person-years (28.1/100,000 in men and 13.2/100,000 in women). TBI was the cause of death in 1.8% of all deaths in the Finnish population during the study years, but in patients aged 16-19 years, TBIs caused more than 17% of all deaths. The most common external cause of fatal TBI was a fall (70%), followed by poisoning or toxic effects (20%) and violence or self-harm (15%) overall. In men, the order of the most common causes of fatal TBI was similar to overall results (64%, 25%, and 19%, respectively), while in women, the most common cause was a fall (82%), followed by complications in healthcare (10%) and poisoning or toxic effects (9%). Cardiovascular diseases, psychiatric diseases, and infections were the most common diseases contributing to death. Blood pressure (lowering) medications were the most common type of medications used before fatal TBI. CNS medications were the second most common medication group. In the context of fatal TBI in Europe, Finland remains at the upper end of fatal TBI incidence. TBI is a common cause of death in young adults, whereas the incidence of fatal TBI becomes increasingly higher with age in Finland. Cardiovascular diseases and psychiatric conditions were the most common diseases related to death, with opposite age trends. Healthcare facility complications were an alarmingly common cause of death in women with fatal TBI.

8 Incident TBI among a Nationwide Cohort of US Older Adults

Objective:Traumatic brain injury (TBI), very common in the United States (US) and occurring at highest rates in older adulthood, is a documented risk factor for cognitive impairment and dementia. However, the full scope of the problem is unknown, as comparative incidence of TBI among older adults is poorly characterized. Moreover, the effect of demographics (race/ethnicity, sex) and cognitive and medical status, as well as education, socioeconomic status, and other social determinants of health (SDOH) on TBI risk is not well understood. We aimed to explore the impact of demographics, cognitive and medical status, and SDOH on vulnerability to new TBIs among older adults.Participants and Methods:Enrollees 65 and older in the nationally representative Health and Retirement Study (HRS) who consented to have their survey data linked to Medicare claims and had not experienced a head injury prior to HRS enrollment were studied. We used claims data 2000-2018 to obtain incident TBI diagnoses and harnessed the detailed demographic, cognitive, medical, and SDOH information available in the HRS. Incident TBI was defined using inpatient and outpatient International Classification of Disease (ICD 9 and 10) codes received the same day as an emergency room (ER) visit code and a computed tomography (CT) scan code, occurring after the enrollee’s baseline HRS interview. We calculated descriptive statistics and bivariate associations for TBI status with demographic and SDOH characteristics measured at baseline using sample weights to account for the complex survey design.Results:Of respondents meeting inclusion criteria (n=9273) during the study follow-up period of 18 years, 8.9% received emergency room treatment for a TBI. Older adults who experienced TBI during the study period were more likely to be female (p=0.0006), and white (p=0.0001), to have normal cognition (vs. cognitive impairment or dementia, p=0.0011), higher education (p&lt;0.0001), and higher income (p=0.01). Having lung disease (p=0.0003) or functional impairment (p=0.03) at baseline were protective against experiencing a TBI.Conclusions:Our results suggest that almost 9% of US older adults received ER treatment for a new TBI during the 18-year study period, and that race, sex, and SDOH factors may increase risk for, or be protective against, TBI. This novel investigation into the impact of demographics and SDOH on incident TBI suggests access to care may impact who gets treatment for TBI. Further study is indicated and may lead to opportunities for both targeted intervention (e.g., primary TBI prevention) to groups most at risk as well as identification and mollification of the most relevant structural and contextual factors (e.g., access to care) to reduce risk of TBI among older adults.

Alcohol Consumption and Helmet Use in Patients with Traumatic Brain Injury due to Motorcycle Accident

AbstractAlcohol consumption is an important risk factor for traumatic brain injury (TBI), and it has a great impact on its incidence and severity. However, studies suggest potential beneficial effects of alcohol during hospitalization and in the prognosis of moderate or severe TBI, with conflicting results. The objective of the present study was to associate alcohol consumption and helmet use in TBI patients, as well as the prognostic variables and patterns of injuries secondary to TBI. We analyzed 109 medical records of patients who suffered TBI due to a motorcycle accident. We evaluated data on alcohol consumption, helmet use, TBI severity, and tomographic findings on admission. The subjects with moderate or severe TBI were evaluated regarding hospitalization, mortality and prognosis variables. Patients who wore a helmet at the time of trauma had lower rates of skull fracture and extradural hematoma (EDH), but an increased incidence of subarachnoid hemorrhage (SAH). Furthermore, patients with moderate or severe TBI who were those under alcohol intoxication had a greater need for Intensive Care Unit (ICU) admission and a tendency to have a lower in-hospital mortality rate and a higher score on the Glasgow Prognostic Score (GPS). Thus, although the consumption of alcohol has an impact on the incidence and severity of TBI at admission, it seems to be related to a lower in-hospital mortality rate and a better prognosis. In addition, helmet use is essential to prevent injuries from direct head-to-shield impact, but no similar reduction in the incidence of injuries caused by indirect forces was observed.

Survival and Functional Outcome in Children with Traumatic Brain Injury Requiring Ventilatory Support: A Prospective Observational Pilot Study

Abstract Background In children, incidence of traumatic brain injury is high and identifying predictors of poor outcome can help clinicians make decisions in the acute phase of treatment. We thus planned to analyze the survival and functional outcome of children following traumatic brain injury. Our study included children (1–10 years of age) requiring ventilation and admitted to trauma intensive care unit of our hospital following traumatic brain injury. Our primary aim was to determine patient outcome using the modified Glasgow Outcome Scale at 3 months following hospital discharge. Our secondary objectives included patient outcome at 1 month following discharge and factors which may affect outcome. Methods Data (epidemiological, clinical, radiological data, and hospital course) of possible factors affecting survival and outcome of pediatric traumatic brain injury patients were collected. Patient outcome was determined using the modified Rankin Scale at the time of hospital discharge and modified Glasgow Outcome Scale at 1and 3 months following discharge. Results At the time of hospital admission, 60% children had a Glasgow Coma Scale score of 3 to 8, and were admitted with severe head injury. At the time of discharge, 30% children had good functional outcome, with 50 and 58% children being functionally independent at 1 and 3 months following discharge, respectively. Deranged serum sodium level was an independent predictor of poor neurological outcome on multivariate analysis (coefficient: −3.90 [−5.14 to –2.66, p &lt; 0.001]). Conclusion Fifty-eight percent children, who were admitted to intensive care unit for mechanical ventilatory support, were functionally independent at the end of 3 months following discharge from the hospital, with modified Glasgow Outcome Scale score of 5 or “Normal.” Deranged electrolytes result in secondary brain injury, thus contributing to poor long-term outcome. Effective electrolyte management is essential to improve outcome after traumatic brain injury in children.