Head Injury Mortality Research Articles

Rekha Kardile4

Rekha Kardile4

PEDIATRIC HEAD TRAUMA: A DESCRIPTION OF CAUSES, NEUROLOGICAL MORBIDITY AND INPATIENT MORTALITY IN A REFERENCE CENTER IN NORTHEASTERN, BRAZIL

The socioeconomic impact of children with sequelae of head trauma is an important public health concern. This retrospective study assessed the causes, the neurological morbidity and the mortality of pediatric head injury during the hospital stays in a referral center in northeastern Brazil. A random sample of 282 medical records of pediatric head trauma cases from a twelve-month period was examined. Patient characteristics, mechanisms of trauma and imaging results were retrieved, and the occurrence of motor deficits, language impairment, cerebrospinal fluid leak seizures or death was assessed during the whole hospital stays. The most affected age range was that of infants (41.5%), the most frequent reported cause was fall (76.5%) and most children were victims of mild brain injury (96%). A total of 11.7% of the computerized tomography examinations showed traumatic injuries, with fractures in 43.6% of them. Thirteen children presented with the above-mentioned endpoints of morbidity and mortality. Seizure (n=9) was the most frequent one. The age range with the highest incidence was also that of infants (n=6). For the same endpoints, the clinical morbid-mortality was 4.6% for the wholes series and 44,4% for moderate and severe trauma. The mortality rate at the end of the period of hospitalization was 1.1%. According to the data from the present study, falls were the main reported cause of pediatric head trauma. A total of 4.6% of victims presented with neurological endpoints of morbid-mortality during the hospital stay and seizure was the most frequent one.

Clinicopathological Characteristics of Traumatic Head Injury in Juvenile, Middle-Aged and Elderly Individuals.

BackgroundTraumatic head injury is a leading cause of death and disability worldwide. How clinicopathological features differ by age remains unclear. This epidemiological study analyzed the clinicopathological features of patients with head injury belonging to 3 age groups.Material/MethodsData of patients with traumatic head injury were obtained from the Department of Cerebral Surgery of the Affiliated Hospital of Guizhou Medical University and the Guizhou Provincial People’s Hospital in 2011–2015. Their clinicopathological parameters were assessed. The patients were divided into 3 age groups: elderly (≥65 years), middle-aged (18–64 years), and juvenile (≤17 years) individuals.ResultsAmong 3356 hospitalizations for traumatic head injury (2573 males and 783 females, 654 died (19.49%), the highest and lowest mortality rates were in the elderly and juvenile groups, respectively. Fall was the most common cause in juvenile and elderly individuals (32.79% and 43.95%, respectively), while traffic injury was most common in the elderly group (35.08%). The manners of injury differed considerably among the 3 age groups. Scalp injury, skull fracture, intracranial hematoma, and cerebral injury were the most common mechanisms in juvenile (67.32%), middle-aged (63.50%), elderly (69.56%) and middle-aged (90.44%) individuals, respectively. Scalp injury and skull fracture types differed among the groups. Epidural, subdural, and intracerebral hematomas were most common in juvenile, middle-aged, and elderly individuals, respectively. Cerebral contusion showed the highest frequency in the 3 groups, and concussion the lowest.ConclusionsPatients with traumatic HI show remarkable differences in clinicopathological features among juvenile, middle-aged, and elderly individuals.

COMPARATIVE ANALYSIS OF ACCURACY AMONG GLASGOW COMA SCALE, TRAUMA SCORE, AND REVISED TRAUMA SCORE AS PREDICTORS OF MORTALITY HEAD INJURY PATIENTS

Measurement of severity and mortality predictions in cases of head injury is an important step to support appropriate, effective and efficient clinical decision-making. Glasgow Coma Score, Trauma Score, and Revised Trauma Score are physiologycal scoring systems that can be used as predictors of mortality of head injury patients. The objective of the study was to know which scoring systems had the best accuracy as a predictor of mortality of head injured patients. The observational analytic study with this retrospective cohort design approach was carried out at dr. Iskak Tulungagung on Medical Record. Data taken from all patient medical records from January 2016 to July 2017 amounted to 150 medical records. Variables used were GCS, RTS, and TS scores when patients were admitted to hospital IGD as well as patient mortality data within 7 days of treatment. The data obtained is then processed with SPSS 20 using Mann Whitney Test, logistic regression and ROC curve comparison. Based on the results of multivariate logistic regression analysis, GCS accuracy results: sensitivity= 0.7586, specificity= 0.7934, PPV= 0.468, NPV= 0.932; RTS accuracy: sensitivity= 0.766, specificity= 0.8, PPV= 0.489, and NPV= 0.932; TS accuracy: sensitivity= 0.7, specificity= 0.783, PPV= 0.4468, NPV= 0.9126. The comparison graph analysis of ROC curve showed no significant difference of AUC between GCS, RTS, and TS because the difference was too low (<15%). There was no significant difference of accuracy between RTS, GCS, and TS use in predicting head injury mortality

The effect of anatomic location of injury on mortality risk in a resource-poor setting

IntroductionInjury is a significant cause of death, with approximately 4.7 million people mortalities each year. By 2030, injury is predicted to be among the top 20 causes of death worldwide. We sought to characterize and compare the mortality probability in trauma patients in a resource-poor setting based on anatomic location of injury. MethodsWe performed a retrospective analysis of prospectively collected data using the trauma database at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. We included all adult trauma patients (≥16years) admitted between 2011 and 2015. We stratified patients according to anatomic location of injury, and used descriptive statistics to compare characteristics and management of each group. Bivariate analysis by mortality was done to determine covariates for our adjusted model. A Cox proportional hazard model was performed, using upper extremity injury as the baseline comparator. Descriptive statistics were used to describe the trend in incidence and mortality of head and spine injuries over five years. ResultsOf the 76,984 trauma patients who presented to KCH from 2011 to 2015, 49,126 (63.8%) were adults, and 8569 (17.4%) were admitted. The most common injury was to the head or spine, seen in 3712 patients (43.6%). The highest unadjusted hazard ratio for mortality was in head and spine injury patients, at 3.685 (95% CI=2.50–5.44), which increased to 4.501 (95% CI=2.78–7.30) when adjusted for age, sex, injury severity, transfer status, injury mechanism, and surgical intervention. Abdominal trauma had the second highest adjusted hazard of mortality, at 3.62 (95% CI=1.92–6.84) followed by thoracic trauma (HR=1.3621, 95% CI=0.49–3.56). ConclusionIn our setting, head or spine injury significantly increases the hazard of mortality significantly compared to all other anatomic injury locations. The prioritization of timely operative and non-operative head injury management is imperative. The development of head injury units may help attenuate trauma- related mortality in resource poor settings.

Mortality of head injuries in Sub-Saharan African countries: The case of the university teaching hospitals of Cameroon

BackgroundReliable data on severe head injury mortality is rarely reported in Sub-Saharan African countries and in Cameroon in particular. It was for this reason that for the first time ever a prospective study was carried out during a one year period in the university hospitals and some selected regional and district hospitals in Cameroon. Materials and methodsAll the patients admitted for head injury in the emergency units of the selected hospitals were enrolled and followed up over a period of one month. ResultsA total of 2835 consecutive patients were included with a sex ratio M/F=3.7/1. One hundred and seventy nine (179) patients lost to follow up were not included. The mortality rate was 77% in the severe head injury group, 16% in the moderate head injury group and 1% in the mild head injury group. In the group of severely injured patients, the mortality rates were very high in the academic hospitals (Laquintinie Hospital of Douala, General Hospital of Douala, Yaounde Central Hospital, and Yaounde University Hospital; 83%, 83%, 81%, and 73% respectively) and in the Regional Hospital of Garoua (84%). ConclusionMortality rates associated with head injury remain very high in Cameroon, and this is likely true in many countries across Sub-Saharan Africa. The figures approach the mortality expected in the natural history of the disease. Strategic plans should be taken at the local and national levels as in the case of maternal mortality and HIV infections.

Traumatic brain injury: Does gender influence outcomes?

Background:Traumatic brain injury (TBI) is a major public health problem. Both genders are affected, but little is known about female TBI. The present study exclusively explores epidemiological, clinical, imaging, and death aspects of female TBI, and how it differs from males.Methods:It is a retrospective study. Data were documented from a tertiary institute during January 2010 to March 2010. All variables were documented on standard proforma. The data were analyzed using R statistics software. Age group was categorized into pediatric (<18 years), middle (19–60 years) and elderly (>61 years). Significance was tested using Chi-square test at the significance level of P < 0.05.Results:Data of 1627 TBI patients were recorded. Of the total, female TBIs contributed nearly 20%. Compared to males, female patients reported higher percentages in manifesting symptoms (84.3% vs. 82.6%), injuries due to fall (32.1% vs. 24.4%), and surgical interventions (11.6% vs. 10.4%). Female patients were significantly higher in mild head injury group (76.8% vs. 69.5%, P - 0.016) and mortality (3.4% vs. 1.6%, P - 0.048). Number of patients and deaths was more among females than males in pediatric and elderly age group. Severities of injuries were more among female patients than male patients in middle and elder age groups.Conclusion:The study results observe that female TBI group differ significantly in the severity of injury and mortality.

Emergency medical services interval and mortality in significant head injury

Recent interest has focused on reorganizing emergency medical services (EMS) for English traumatic brain injury (TBI) patients, with bypass of nonspecialist hospitals and direct transportation to distant neuroscience centres. This may expedite specialist neurocritical care and neurosurgical interventions, but risks harms from prehospital deterioration and delayed resuscitation. We therefore aimed to investigate the effect of EMS interval on outcome following head injury. We performed a multicentre cohort study examining adult patients with significant TBI (head region abbreviated injury scale ≥3) enrolled in the Trauma Audit and Research Network trauma registry between 2005 and 2011. The association between EMS interval and mortality in patients directly admitted to specialist neuroscience centres was explored using bivariate and multivariate logistic regression and propensity score matching analyses. In all, 7149 eligible patients presented directly to specialist neuroscience centres during the study period. Adjusted odds ratios for mortality showed no association between EMS interval and mortality, varying from 0.46 (95% confidence interval 0.1-2.6) for EMS intervals under 20 min to 0.67 (95% confidence interval 0.4-1.2) for EMS intervals more than 120 min (reference EMS interval 40-60 min). This lack of association was also observed following matching using propensity scores, with no significant difference apparent in mortality between EMS intervals less than 60 min and more than 60 min (17.85 vs. 17.0%, P=0.826). These results were unaffected in sensitivity analyses examining missing covariate data or unmeasured outcomes. The lack of observed association between EMS interval and mortality may not preclude bypass of significant TBI patients, with concomitantly prolonged primary transfers from the scene of injury to distant specialist centres. However, given the limitations of registry data, our results should be interpreted with caution.

Intensive Care Treatment in Traumatic Brain Injury.

Head injury remains a serious public problem, especially in the young population. The understanding of the mechanism of secondary injury and the development of appropriate monitoring and critical care treatment strategies reduced the mortality of head injury. The pathophysiology, monitoring and treatment principles of head injury are summarised in this article.

The effect of alcohol intoxication on mortality of blunt head injury.

Alcohol is found to have neuroprotection in recent studies in head injuries. We investigated the association of blood alcohol concentration (BAC) with mortality of patients with blunt head injury after traffic accident. All patients sustaining blunt head injury caused by traffic accident brought to our emergency department who had obtained a brain computed tomography scans and BAC were analyzed. Patients with unknown mechanisms, transfers from outside hospitals, and incomplete data were excluded. Logistic regression was used to identify independent predictors of mortality. During the study period, 3,628 patients with brain computed tomography (CT) were included. Of these, BAC was measured in 556 patients. Patients with the lowest BAC (less than 8 mg/dl) had lower mortality; intoxicated patients with BAC between 8 and less than 100 mg/dl were associated with significantly higher mortality than those patients in other intoxicated groups. Adjusted logistic regression demonstrated higher BAC group and Glasgow coma scale (GCS) scores, and lower ISS and age were identified as independent predictors of reduced mortality. In our study, we found that patients who had moderate alcohol intoxication had higher risk of mortality. However, higher GCS scores, lower ISS, and younger age were identified as independent predictors of reduced mortality in the study patients.

Head Injury Incidence and Mortality in New Zealand over 10 Years

Background: Although reducing the burden of head injuries is an important focus of several injury prevention initiatives, they remain a large proportion of injury-related deaths. In New Zealand, trends over time and the socio-economic distribution of the cause-specific incidence of head injuries have received little attention. Methods: We analyzed primary hospitalizations (2000-2009) and deaths (1999-2008) due to head injury using national mortality and hospital discharge databases, specifically exploring variations in age-specific rates by major causes over time and by socio-economic deprivation. Population-based incidence rate estimates were calculated using census denominators. Results: Children aged <5 years and adults aged ≥65 years had the highest rates of hospitalization and mortality, respectively. Transport-related incidents and falls were the leading causes, with most fatal injuries occurring on roads and most hospitalized injuries occurring at home. There was a significant increase in mortality rates among older adults over the decade, and in most age groups, mortality rates increased with increasing levels of socio-economic deprivation. Conclusions: The findings of this review alongside the significant risks of premature death and disability reinforce the need to explore policies that address the specific causes as well as socio-economic inequalities in their distribution in New Zealand.

Motorcycle injuries at a tertiary referral hospital in Kenya: injury patterns and outcome.

The rise in the use of motorcycles in Kenya in the last 10years has been associated with increased injury rates. Between 2004 and 2009, motorcycle injuries increased at a rate of 29% and, in some hospitals, motorcycle users have become the predominant road user category injured. Although most road traffic injuries occur in Nairobi, there has been no previous account of motorcycle injury and associated outcomes at its main hospital. To describe the injury patterns and outcomes following motorcycle trauma at the Kenyatta National Hospital. All motorcycle trauma admissions during one calendar year were analyzed. The data captured included demographics, injury patterns and outcomes, lengths of hospital stay, hospitalization cost, and early hospital mortality. Factors associated with outcomes were analyzed by univariate and multivariate means. The probability of survival was estimated using the Trauma and Injury Severity Score (TRISS) methodology for each patient. Two hundred and five patients were reviewed. Motorcycle trauma admissions formed 22.3% of all road traffic injury admissions. Male riders predominated. The average age and modal age group was 30.78 and 21-30years, respectively. Half of riders and 20% of passengers used protective helmets. Injuries were mostly to the extremities (60.7%) and head/neck (32.07%), and the average Injury Severity Score (ISS) was 7.57+4.0 (median 9.0). At 2weeks, 9.0% of patients had died. The estimated probability of survival ranged from 0.86 to 0.97. Surgical interventions were needed for 51.7% of patients. The mean length of stay in the hospital was 24.3days, while the cost of treatment was 31,783 Kenya Shillings (Kshs). Injury severity (P<0.001), admission to the intensive care unit (ICU) (P<0.001), non-surgical treatment (P = 0.003), blood transfusion (P = 0.029), head injury (P<0.001), and low Glasgow Coma Scale (GCS) score at admission were significantly associated with mortality. Injuries to the lower limbs and the head predominate in motorcycle trauma. The high mortality rate, need for surgery in the majority of patients, and prolonged admission days call for motorcycle control and expedited care. Significant head injury mortality calls for efforts to embrace helmet laws for riders and passengers.

Head injury triage in a sub Saharan African urban population

BackgroundInjuries are the ninth leading cause of death in the world and disproportionately affect low- and middle-income countries. Head injury is the leading cause of trauma death. This study examines the epidemiology and outcomes of traumatic head injury presenting to a tertiary hospital in Malawi, in order to determine effective triage in a resource limited setting. MethodsThe study was conducted at Kamuzu Central Hospital (KCH) in Lilongwe Malawi during a three-month period. Vital signs and Glasgow Coma Score (GCS) were prospectively collected for all patients that presented to the casualty department secondary to head injury. All head injury admissions were followed until death or discharge. ResultsDuring the three-month study period, 4411 patients presented to KCH secondary to trauma and 841 (19%) had a head injury. A multivariate logistic regression model revealed that GCS and heart rate changes correlated strongly with mortality. There is a four-fold increase in the odds of mortality in moderate versus mild head injury based on GCS. ConclusionIn a resource limited setting, basic trauma tools such as GCS and heart rate can effectively triage head injury patients, who comprise the most critically ill trauma patients. Improvements in head injury outcome require multifaceted efforts including the development of a trauma system to improve pre-hospital care.

Opportunities for improved trauma care of the elderly – A single center analysis of 2090 severely injured patients

PurposeWestern trauma centers are increasingly confronted with elderly trauma patients in parallel to an increase of the elderly population. The purpose of this study was to identify shortcomings and opportunities for improvement in the treatment of elderly trauma patients. Materials and methodsRetrospective analysis of a prospectively collected single-center trauma database. Patients were grouped according to age and analyzed using univariate and multivariate analysis. Results158 patients (7.6%) were older than 75years, and 604 patients (28.9%) were between 50 and 75years. Although comparable with respect to injury severity (injury severity score (ISS) 29–33) and age-adjusted Acute Physiologic and Chronic Health Evaluation (APACHE) score, there was a significant increase in mortality beyond the age of 50 (>75years: 63.9%), with age being an independent predictor of mortality. Despite a similar rate and severity of head injuries (affecting 71% of all patients), mortality of head injuries was highest in patients >75years (70.2%), accounting for the increased mortality in this group. Patients >75years old were less likely to undergo craniotomy, and withdrawal of medical support occurred five times more frequently. Surviving patients ≥50years required shorter ICU care than patients below 50years (7.8 vs. 12.4days). ConclusionsWith increasing life expectancy and sustained independence, elderly trauma patients have become a regular occurrence in trauma services. Despite comparable injury severity and physiologic status upon admission, these patients suffer from disproportionately high mortality rates. Closed head injuries account for the majority of fatalities, regardless of the extent of therapeutic measures applied.

Meta - analysis of epidemiology and clinical charateristics of head injuries in the Wenchuan earthquake

Objective To estimate the epidemiology and clinical characteristics of patients with head injuries in Wenchuan Earthquake. Methods A comprehensive study of clinical data and literature meta - analysis evaluation of the 2008 - 2011 published articles on the traumatic brain injuries caused by the Wenchuan earthquake were carried out. Results Totally 68 retrieved documents met the essential requirements.According to the literature inclusion criteria,there were 18 papers were enrolled into the standard meta- analysis.They were sampled from all 3 involved provinces as Sichuan,Shanxi and Gansu.And this covered the 26 earthquake hit and severe hit regions.As the cumulative statistical showed that the earthquake injured 32 415 people,in which 5 559 people had head injuries ( 17.1％ ).The Male:female ratio was 1.53:1.The mild earthquake caused head injuries accounted for 69.4％,moderate 21.0％,and severe 9.6％.The open head injuries accounted for 17.7％ and combined injuries accounted for 54.7％.The mortality rate of earthquake caused head injury mortality rate was 0.16％.Conclusions Head injuries caused by the Wenchuan earthquake have some characteristics such as the high incidence,the complicated injury mechanism,combined injuries,nulti - injuries,rapid clinical changes and so on.And to improve the emergency response to victims of disaster in different stages’ hospitals would play greatly important role in increasing the rescue survival and reducing the disability and death rate. Key words: Earthquake ; Craniocerebral trauma; Epidemiology ; Treatment ; Meta- analysis

Plasma levels of oxidative stress biomarkers and hospital mortality in severe head injury: A multivariate analysis

IntroductionThe association between biomarkers of oxidative stress and the prognosis of patients with traumatic brain injury (TBI) remains inconclusive. ObjectiveThe objective was to investigate the association between plasma levels of lipid peroxidation (thiobarbituric acid reactive species [TBARS]) and protein oxidation (carbonyl) biomarkers and the hospital mortality of patients with severe TBI. MethodsPlasma levels of TBARS and carbonyl were determined in 79 consecutive patients with severe TBI (Glasgow Coma Scale [GCS] ≤8) at a median of 12 hours (interquartile range [IQ] 25-75, 6.5-19.0), 30 hours (IQ 25-75, 24.7-37.0), and 70 (IQ 25-75, 55.0-78.5) hours after TBI and were compared with age- and sex-matched controls. The association between the TBARS and carbonyl levels and the hospital mortality was analyzed by multiple logistic regression analysis. ResultsThe mean age of patients was 34.8 years. Eighty-six percent were male. The TBARS and carbonyl levels were significantly higher in patients than in controls. There was a trend (P = .09) for higher plasma levels of TBARS and carbonyl proteins at 12 hours, but not at 30 or 70 hours, after trauma in nonsurvivors than in survivors. These findings were not confirmed after the adjustments by multiple logistic regression analysis. The final model showed a higher adjusted odds ratio for death for patients with admission GCS lower than 5 (odds ratio [OR] = 4.04; 95% confidence interval [CI], 1.33-12.13; P = .01) than those with higher GCS scores. Abnormal pupils were also associated with higher mortality (OR = 3.97; 95% CI, 1.22-12.13; P = .02). There was a nonsignificant trend for association between glucose greater than or equal to 150 mm/dL in the first 12 hours and death than levels between 70 and 149 mg/dL (OR = 2.92; 95% CI, 0.96-9.02; P = .06). ConclusionsPlasma levels of TBARS and carbonyl increase significantly in the first 70 hours after severe TBI but are not independently associated with the hospital mortality.

Comparison of regression tree data mining methods for prediction of mortality in head injury

With this research, we sought to examine the performance of six different regression tree data mining methods to predict mortality in head injury. Using a data set consisting of 1603 head injury cases, we assessed the performance of: the Classification and Regression Trees (CART) method; the Chi-squared Automatic Interaction Detector (CHAID) method; the Exhaustive CHAID (E-CHAID) method; the Quick, Unbiased, Efficient Statistical Tree (QUEST) method; the Random Forest Regression and Classification (RFRC) method; and the Boosted Tree Classifiers and Regression (BTCR) method, in each case based on sensitivity, specificity, positive/negative predictive, and accuracy rates. Next, we compared their areas under the (Receiver Operating Characteristic) ROC curves. Finally, we examined whether they could be grouped in meaningful clusters with hierarchical cluster analysis. Areas under the ROC curves of regression tree data mining methods ranged from 0.801 to 0.954 ( p < 0.001 for all). In predicting mortality in head injury under the ROC curve, the BTCR method achieved both the highest area (0.954) and accuracy rate (93.0%), while the CART method achieved both the lowest area (0.801) and accuracy rate (91.1%). All of the regression tree data mining methods were clustered in the same grouping, but the BTCR method was at the origin of the cluster while the CART and QUEST methods produced results that were least like the others. The BTCR, demonstrating a 93.0% accuracy rate and showing statistically significantly differences from the others, may be a helpful tool in medical decision-making for predicting mortality in head injury.

Comparison of mortality following hospitalisation for isolated head injury in the UK and Victoria, Australia

BackgroundHead injury remains a leading cause of death and disability worldwide but advances in trauma systems, pre-hospital care, and critical care have led to improvements in survival.AimsCompare isolated head injury...

Gender as a Moderator of Cognitive and Affective Outcome After Traumatic Brain Injury

Gender as a Moderator of Cognitive and Affective Outcome After Traumatic Brain Injury

Despite overall low pediatric head injury mortality, disparities exist between races

Background To continually improve quality of care, it is important for centers caring for children with head injury to evaluate their overall outcome and that among diverse patient groups. Methods Data on children with head injuries were extracted from the National Trauma Data Bank of the American College of Surgeons and our local trauma registry. Unadjusted mortality, as well as stratified analysis and logistic regression modeling, was used to evaluate overall and race-specific mortality. Results There were 13,363 children in the National Trauma Data Base and 3111 in our database included. Our overall mortality rate compared favorably with the national data (3.2% vs 6.8%, P < .05). Our local data, however, showed a significant difference in mortality between white and African American (AA) children (2.2% vs 5.3%, P < .05), which was not identified in the national data. After stratification, the disparities by race persisted. Finally, multivariate regression modeling revealed that AA race was an independent predictor of mortality among our patient population, with an odds ratio of 3.1 (95% confidence interval, 1.2-7.8). Conclusion Despite excellent outcomes for children with head injuries, we have uncovered unsettling inequities between AA and white children. These findings support the need to evaluate outcomes among specific groups to identify disparities that require further careful investigation.