Sustained Head Injuries Research Articles

Mechanism of injury, resource utilisation and outcomes for patients admitted with head injuries under General Surgery.

There has been a noticeable change in Irish hospitals in the demographics of patients sustaining head injuries that now includes many older patients suffering head injuries from low impact trauma. This study sought to define the demographic nature of patients admitted with head injuries over a 3-month period to Beaumont Hospital and to determine the mechanisms of head injuries sustained, resource utilisation during the inpatient admission and the outcomes for these patients. All head injuries admitted between December 1, 2023, and February 29, 2024, were captured and data pertaining to patient demographics, mechanism of injury, resource utilisation and outcomes were assessed. A comparison between patients under the age of 70 and over the age of 70 was also undertaken. Thirty six patients were admitted in the 3-month period. 52.8% (n = 19) were over the age of 70. The mechanism of injury in the older cohort had a tendency to be low impact trauma, often with mechanical falls from standing height The median length of stay was 4.5days. The older cohort was more likely to have a history of previous falls, to require input from allied health and social care professionals and were less likely to be discharged directly home. Older patients requiring hospital admission for head injuries have significantly different care needs to younger patients admitted with head injuries. A national pathway for older patients who sustain head injuries needs to be implemented to ensure they get timely access to the investigations and specialists required.

Head injuries related to bicycle collisions and helmet use – an observational study

Objectives In Denmark, the use of bicycles is widespread, and head injuries are often seen in cyclists involved in collisions. Despite the well-known effects of using a helmet to reduce head injuries, using helmets is not mandatory in Denmark. The primary objective of this study was to provide data regarding injury outcomes and helmet usage. Methods Participants were bicyclists who sustained head injuries in bicycle collisions and were assessed by the Copenhagen Emergency Medical Services between 1 January 2016; and 15 June 2019. Patients with suspected head injury were identified in an electronic prehospital patient record. Data were linked to the Danish National Patient Registry to retrieve the diagnosis and were categorized into head injury or no head injury based on the diagnosis. Adjusted logistic regression analyses were reported with odds ratios and corresponding confidence intervals to assess the risk of head injury while adjusting for risk factors like age, sex, alcohol consumption, occurrence during weekends and traumatic brain injury. Results A total of 407 patients were included in this study. Within this entity, 247 (61%) had sustained a head injury. The use of a helmet was reported in one-third of the included patients. Among the head-injured patients, 13% sustained moderate to severe head injuries. Patients with suspected alcohol involvement were significantly less likely to report the use of a helmet. Helmet use reduced the risk of head injury with an odds ratio of 0.52, (95% CI 0.31 − 0.86). In high-energy trauma, the use of a helmet showed a significant reduction in the risk of sustaining a head injury with an odds ratio of 0.28, (95% CI 0.12 − 0.80). Conclusions In this study, using a helmet was associated with a significantly decreased risk of head injury; this association was even more significant in high-energy trauma.

Review of a large trauma registry in Addis Ababa, Ethiopia: insights into prehospital care and provider training for trauma quality improvement

BackgroundInjury is a major cause of death and disability in Ethiopia. ALERT Hospital, one of only three designated trauma centers in the country, has employed a basic trauma registry since...

Pattern and distribution of injuries associated with road traffic accident in Haldwani (Nainital) - An autopsy based study

Indiais one of the fastest growing economies. There is a rapid inflation of vehicles on the road that range from motorcycles to heavy vehicles which also shows an active surge in the fatal road accidents. This study is focussed to find out the pattern and distribution of injuries in fatal road traffic accident cases in Kumaon region of Uttarakhand as to plan at the time of policy making and traffic law implementation.: The present study was conducted in the department of Forensic Medicine & Toxicology of Government Medical College, Haldwani from January 1 2019 to December 31 2019, on total 110 cases of RTA brought to mortuary for medico-legal post mortem examination.: Maximum number of cases sustained head and neck injuries (42 out of 110 externally) followed by extremities injury (28 out of 110). Total 38 cases out of 110 sustained head and neck injuries internally, followed by abdominal injuries (28 cases). Abrasions (30 cases) and laceration (29 cases) were commonest type of external injury noted in RTA cases followed by contusion (22 cases) and fracture (19 cases). Most common cause of death among RTA victims was head injury (40 out of 110 cases) followed by shock and haemorrhage (37 out of 110 cases).

A prospective study on the incidence and outcome of cranial nerve injuries in patients with traumatic brain injuries

Background: The worldwide mortality and morbidity rates are highest for traumatic brain injury (TBI), which frequently involves damage to the cranial nerves (CNs). The occurrence of CN injury (CNI) in craniocerebral trauma ranges from 5 to 23%. Aims and Objectives: The objective of this study is to evaluate the occurrence of CNI in TBI patients within our population and determine the association between CN involvement and the severity of head injuries. In addition, we aim to assess the outcomes of patients who experience CNI in cases of head trauma. Materials and Methods: In our institution, a prospective observational analytical study was conducted from July 2022 to June 2023. The study included 100 patients aged over 1 year who had sustained head injuries. These patients were followed up for a period of 6 months. Results: Our study included a total of 100 patients, revealing that the highest number of head injuries occurred within the age range of 20–60 years, with an average age of 46 years. Among the study population, males accounted for 74%. Of these patients, 66 had mild head injuries, 22 had moderate head injuries, and 12 were admitted with severe head injuries. We discovered that 15% of TBI patients experienced CNIs. Specifically, five patients had a single CN palsy, while three patients had multiple CN palsies. Road traffic accidents accounted for 78% of the cases, making them the most common cause of injury, while low-velocity injuries only made up 22% of the cases. The facial nerve was the CN most frequently affected, followed by the olfactory nerve, optic nerve, and vestibulocochlear nerve. Among the 15 patients with CNI, seven had delayed symptoms, whereas eight patients presented with immediate symptoms. Conclusion: A substantial proportion of patients experience a delayed onset of CNI symptoms. Therefore, it is essential to perform a comprehensive neurological examination of all CNs during follow-up for all TBI patients.

Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation.

Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities. We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance. A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test. Of the 26 patients enrolled, 12 (46%) were female, 18 (69%) were on anticoagulants, and 25 (96%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age (χ12=4.27; P=.04) but not sex (χ12=1.58; P=.23) or race (χ12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit. The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population.

Driving Under the Influence of Alcohol among Road Traffic Accident Patients Presenting to a Tertiary Care Centre.

Driving under the influence is one of the most significant risk factors for road traffic accidents, leading to severe and multiple orthopaedic injuries. The aim of this study was to find out the prevalence of driving under the influence of alcohol among road traffic accident patients presenting to a tertiary care centre. A descriptive cross-sectional study was conducted on patients involved in road traffic accidents presenting to a tertiary care centre. Data from 10 January 2020 to 9 December 2021 were collected between 22 July 2023 to 22 August 2023 from the hospital records after receiving ethical approval from the Institutional Review Committee. Patients who had road traffic accidents and were diagnosed with fractures were included in the study. Patients with incomplete hospital records were excluded from the study. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 2,519 patients, 307 (12.19%) (10.91-13.47, 95% Confidence Interval) were driving under the influence of alcohol when involved in a road traffic accident. Out of 307 patients, 305 (99.35%) accidents involved two-wheelers. A total of 118 (38.44%) patients suffered soft tissue injuries, while 47 (15.31%) sustained head injuries, and 28 (9.12%) sustained facial injuries. The prevalence of driving under the influence of alcohol among road traffic accident patients presenting to a tertiary care centre was similar to other studies done in similar settings. accidents; alcohol consumption; bone; Nepal; trauma.

Sex differences in sledging injuries: a retrospective 10-season study from a Swiss level 1 trauma centre

ObjectivesSledging is a popular and traditional winter sport in Switzerland. This study examines injury patterns of patients who presented to a tertiary trauma centre in Switzerland following sledging trauma, focusing...

Trampoline-Associated Cranial and Spinal Injuries: A 10-Year Study in a Pediatric Neurosurgery Center.

There has been an increasing use of trampolines for recreation by children in recent years. Many studies have explored the different types of injuries sustained due to falls from trampolines, but so far none have focused specifically on cranial and spinal injuries. In this study, we describe the pattern of cranial and spinal injuries sustained by pediatric patients that were associated with the use of trampolines and their management in a tertiary pediatric neurosurgery unit over a period of 10 years. This is a retrospective study of all children less than 16 years of agewith suspected or confirmed trampoline-associated cranial or spinal injuries, managed by a tertiary pediatric neurosurgery unit from 2010 to 2020. Data collected included the patient's age at the time of injury, gender, neurological deficits, radiological findings, management, and clinical outcome. The data were analyzed to highlight any trends in the pattern of injuries. A total of 44 patients with a mean age of 8 years (ranging from one year and five months to 15 years and five months) were identified. 52% patients were male. 10 patients (23%) had a reduced Glasgow Coma Scale (GCS) score. In terms of imaging findings, 19 patients (43%) had a radiologically positive head injury, nine (20%) had a craniovertebral junction (CVJ) injury, including the first (C1)and second (C2) cervical vertebrae, and six (14%) had an injury involving other parts of the spine. No patient sustained concurrent head and spinal injuries. Eight (18%) patients had normal radiological findings. Two (5%) had incidental findings on radiology that required subsequent surgery. A total of 31 patients (70%) were managed conservatively. 11 patients (25%) underwent surgery for their trauma, of which seven were cranial. Two further patients underwent surgery for their incidental intracranial diagnoses. One child died from an acute subdural hemorrhage. This study is the first to focus on trampoline-associated neurosurgical trauma and report the pattern and severity of cranial and spinal injuries. Younger children (less than five years of age) are more likely to develop a head injury, whereas older children (more than 11 years of age) are more likely to develop a spinal injury following the use of a trampoline. Although uncommon, some injuries are severe and require surgical intervention. Therefore, trampolines should be used prudently with the appropriate safety precautions and measures.

Chronic Anterior Pituitary Dysfunction Following Traumatic Head Injury: Prospective Study in Hospital Sultanah Aminah Johor Bahru, Malaysia.

Hypopituitarism following traumatic brain injury (TBI) is not rare however most patients were left undiagnosed and untreated. Association of post TBI hypopituitarism causing neurobehavioural and quality of life impairment. The aim of the study is to determine the incidence of the chronic anterior pituitary deficiency in patients with traumatic brain injury. Subsequently determine the risk factor and the outcome of the patient with chronic anterior pituitary dysfunction. This is single centre cross-sectional study involved 105 traumatic head injury patients under the Neurosurgical Department Hospital Sultanah Aminah, Johor Bahru, Malaysia. The primary investigator will do an interview and the patients will be asked question to complete a questioner from SF-36 (36 questions). Subsequently, consent for participation will be taken and blood sampling will be done. Thirty-three patients were noted to have anterior pituitary dysfunction. The mean age was 36.97 ± 12.96 years old. Twenty-seven patients (32.5%) were male and six patients were female (27.3%). Chronic anterior pituitary dysfunction in patients with a severe traumatic head injury around 47.1% (23 patients), as compared to a moderate head injury (8 patients, 38.1%) and 2 sustained mild head injury (5.6%). The mean duration after the onset of trauma was 10.3 ± 1.79 months. All patient with anterior pituitary dysfunction had positive CT brain findings with 22 had subarachnoid haemorrhage (SAH) at the basal cistern and 27 patients had a base of skull fracture, where 52.1% of the patient underwent surgical intervention, 84.8% involved one axis and another 5 patients had two axes involved. Severity of the head injury (P < 0.001), prolonged duration of hospital stay (P = 0.014), radiological findings of a base of skull fracture (P < 0.001) and presence of SAH at basal cistern (P < 0.001) was significantly associated with pituitary dysfunction. The patient with anterior pituitary dysfunction has the lower 36-item Short Form Survey (SF-36) marks 56.3 ± 10.3. The prevalence of hypopituitarism was 31%. Indicators are increased TBI severity, prolonged hospitalisation and positive finding in radiological assessment. Post-traumatic chronic anterior pituitary dysfunction also related with poor quality of life as showed by low SF-36 marks.

Concussion through my eyes: a qualitative study exploring concussion experiences and perceptions of male English blind footballers

ObjectivesAthletes with impairments play sports with a risk of sustaining head injuries and concussions. However, the scientific knowledge needed to improve care is lacking. This qualitative study explores English blind...

Toppling television injuries in children and adolescents: a systematic review and meta-analysis

ContextToppling televisions (TVs) are a source of childhood injury but meta-analysis has not assessed the likelihood of TV injuries in children.ObjectiveTo present pooled results for injuries, following a systematic review.Data...

Comparing rates of skull fractures in female versus male geriatric patients who sustain head injuries

BackgroundHead trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. This study aims to evaluate the role of sex in the risk of skull fracture in patients over the age of 65. MethodsA prospective cohort study was conducted at two level-one trauma centers, serving a population of 360,000 geriatric residents. Over a year-long period, consecutive patients aged 65 years and older who presented with blunt head injury were included. Patients who did not receive head CT imaging were excluded. The primary outcome was rate of skull fracture due to the acute trauma, compared by sex. Additional factors examined included patient race/ethnicity and mechanism of injury. ResultsAmong 5402 patients enrolled, 3010 (56%) were female and 2392 (44%) were male. 4612 (85%) of the head injuries sustained were due to falls, and 4536 (90%) of all subjects were Caucasian. Overall, 199 patients (3.7%) sustained skull fractures. Males had a significantly greater rate of skull fracture when compared to females (4.6% vs 3.0%, OR 1.5, 95% CI: 1.2–2.1, p = 0.002). This trend was also seen across race/ethnicity and mechanism of injury. ConclusionsOlder males were found to have a higher rate of skull fractures compared to females after sustaining blunt head trauma, mostly due to falls.

Discriminant validity of the Structured Inventory of Malingered Symptomatology (SIMS) under conditions of simulating symptoms

Background/Aim. The Structured Inventory of Malingered Symptomatology (SIMS) is a self-report measure to be used with adults, which may be utilized to assess the potential malingering of psychosis, neurologic impairment, amnesia, low intelligence, or affective disorder. The aim of the study was to examine the discriminant validity of SIMS under conditions of simulating symptoms of neurological and memory disorders, in response to a hypothetical situation, after watching a recording of an actual car accident in which a motorcycle rider sustained head injuries. Methods. The study involved 94 students (35 men and 59 women) from the University of Criminal Investigation and Police Studies in Belgrade and the Faculty of Medicine ? Special Education and Rehabilitation in Novi Sad, aged 20?26 [arithmetic mean = 20.69; standard deviation (SD) = 0.80], divided into two groups (n = 4 7), malingerer and control. The malingerer group was instructed to identify with the motorcycle rider hit by the car and malinger symptoms related to neurological difficulties and amnesia in order to obtain greater reimbursement from the insurance company. The control group had instructions to honestly assess the probability of occurrence of the symptoms. Results. The results of the multivariate one-way analysis of variance suggested that the effect of experimental manipulation was statistically significant [F (88, 5) = 91.21, p &lt; 0.001; ?2p = 0.838]. Univariate effects were also statistically significant for all five scales. Participants in the malingerer group scored higher on all five scales than participants in the control group. The magnitudes of the effects support the largest differences between the malingerer and control groups on the scales of Memory Disorders and Neuro-logical Disorders, which was also the basic instruction for simulating symptoms given to the participants in the malingerer group. Conclusion. The obtained results support the discriminant validity of the SIMS questionnaire in the situation of simulating symptoms of neurological disorders and memory disorders.

Statistical approaches for assessing the effectiveness of safety devices use in preventing head injuries from motorcycle crashes

This study investigates the effectiveness of motorcyclist’s helmet use in preventing head injuries using the binary regression model and the mosaic plots. The association between head injuries and helmet use was modeled by applying binary logistic regression. The fitted model to the Changhua city accidents dataset has revealed that wearing a helmet had a positive impact in preventing the motorcyclist from sustaining head injuries in road traffic crashes. In addition to the association between head injuries and non-wearing of helmet, we found that alcohol impairment risk factor was increasing the likelihood of head injuries during crashes. Besides, the results were supported by using the mosaic plots which provide a visualization of the joint effect of Alcohol, helmet and heading injury for motorcyclists involved in crashes.

Characteristics and costs of electric scooter injuries in Helsinki: a retrospective cohort study

Background and purposeThe incidence of electric scooter (e-scooter) injuries has increased drastically in numerous countries after widespread availability of shared e-scooters. The economic impact on society from a broader perspective has not been studied. We aimed to estimate the incidence of e-scooter injuries, describe the injury patterns, and estimate the costs of e-scooter injuries.Patients and methods:We performed a retrospective cohort study including all e-scooter-related injuries presented in the three adult emergency departments in Helsinki in 2021. We collected the patient data from the university hospital information system. Injury severity was evaluated based on the Abbreviated Injury Score. The cost of the hospital treatment was analyzed based on our hospital district’s service price listing. In addition, we recorded the total amount of sick leave days and estimated their economic impact.ResultsIn total, 446 e-scooter injuries were identified and taken into the analysis (434 affecting riders and 12 non-riders). The median age of the patients was 26 (IQR 22–33), and 59% were male. 257 (58%) of the of the injuries were minor, whereas 155 (35%) were moderate, 30 (7%) serious, 3 (0.7%) severe, and one (0.2%) critical. Furthermore, 220 (49%) of the patients sustained head injuries. A major spike in accident incidence was seen during the weekend (Friday to Sunday) nights, accompanied by a proportional increase in patients with alcohol intoxication. Including both the costs of the hospital care and absence from work, the approximated total cost of e-scooter injuries was 1.7 million euros, with a median cost of a single accident being 1148 euros (IQR 399–4263 €).Interpretation:Considerable number of the injuries are moderate, severe, or worse. Comprehensive preventive measures must be conducted to decrease the incidence of e-scooter injuries. The use of helmets should be strongly encouraged to prevent severe head injuries. The nighttime bans during weekends and speed limits on e-scooters appear to be justifiable.

242 Computed Tomography Imaging of Geriatric Patients With Uncertain Head Trauma

While clinical decision rules (CDR) exist for patients who sustain head injuries, there are no tools to use for patients unaware of a potential head trauma event. This is common in patients older than 65 years of age who may have no memory of an injury due to dementia or loss of consciousness. Lack of a CDR for patients with possible, but uncertain trauma may lead to increased and perhaps unnecessary head CT imaging. This study examines geriatric patients who present to the emergency department (ED) with uncertainty of head trauma occurrence.

Injury profiles and epidemiology of single vehicle motorcycle fatalities in Tamil Nadu, India, 2009-2017

This article investigates single-vehicle motorcycle crashes and crash risk where a rider is killed or injured in Tamil Nadu, India. Hospital data linked with police-reported crash data, including demographic information, injury characteristics, and environmental and road characteristics, were analysed for all single-vehicle motorcycle crashes between January 2009 and December 2017. A total of 16,541 single-vehicle motorcycle crashes resulted in injuries (fatal, serious, and minor injury) during the period, among which 7,447 were fatal crashes. The majority of fatal crashes involved male motorcyclists aged between 26 and 64 years (5,287). Those aged 18 and 25 years (1,897) were the next most frequent group of fatally injured motorcyclists. Among the fatal injured motorcyclists, 66.6% were wearing a helmet. When reported, 33.8% of motorcyclists did not have a valid driving licence at the time of the incident. Motorcyclists injured most commonly sustained head injuries (51.3%), followed by multiple injuries (20.1%), leg injuries (3.3%), and hand injuries (3.2%). Logistic regression results suggest that specific road characteristics and environmental factors increase the probability of fatal crashes: urban roads, express highways, multiple lane roads, night time, absence of median divider, cross and T-junctions, junctions with four arms, under-aged (&lt;18 years) riders, not holding a valid licence and non-use of helmets. Appropriate countermeasures to mitigate motorcyclist trauma are recommended.

Patterns, management options and outcome of blunt thoracic aortic injuries: a 20-year experience from a Tertiary Care Hospital

BackgroundBlunt Thoracic aortic injury (BTAI) is the second leading cause of mortality after head injuries in blunt trauma patients. There is a paucity of information on the presentation, management and outcome of BTAIs from the Middle Eastern region. We explored the patterns, management options and outcomes of BTAIs in a level I trauma center.MethodsWe conducted a retrospective observational study on all adult patients who were admitted with BTAIs between 2000 and 2020. Patients were compared for the management option (conservative vs endovascular aortic repair (TEVAR) vs open surgery) and outcomes. Comparison between the respective groups was performed using one-way analysis of variance for continuous variables, and Pearson chi-square test for categorical variables. Kaplan–Meier curve and Cox regression analysis were performed for the outcome.ResultsEighty-seven patients had BTAI (82% male) with mean age 37.3 ± 14.5 years. The mean injury severity score was 30 ± 10 and the aortic injury grade was III (I–IV). Grade III (41.4%) and Grade IV (33.3%) injuries were more common followed by Grade II (13.8%) and Grade I (11.5%). Forty percent of cases were treated conservatively whereas aortic interventions were performed in 60% of cases (n = 52). The TEVAR was performed in 33 patients (63.5%), and 19 (36.5%) were treated with open surgery (14 with graft interposition and 5 with clamp and direct repair). The aortic injury grade was significantly higher in the intervention groups as compared to the conservative group (p = 0.001). Patients with Grade IV injuries were more likely to be treated by open repair whereas a higher frequency of patients with grade III was managed by TEVAR (p = 0.001). All the patients with Grade I–II were treated conservatively. The overall in-hospital mortality rate was 25.3% and it was significantly higher in the conservative group (40.0%) in comparison to the open repair (31.6%) and TEVAR (6.1%) group (P = 0.004). More of the non-survivors sustained head injuries (P = 0.004), had higher ISS (P = 0.001) and greater aortic injury grades (P = 0.002), and were treated non-operatively (P = 0.001).ConclusionsBTAI seems not common in trauma, however, one quarter of cases died in a level 1 trauma center, prehospital deaths were not analyzed, and postmortem examination was lacking. The associated head injury and aortic injury grade have an impact on the management option and hospital outcome. The conservative and TEVAR options were performed almost equally in 78% of cases. TEVAR and open surgery were performed only for aortic injury grade III or IV whereas the conservative treatment was offered for selected cases among the 4 injury grades. However, the mortality was higher in the conservative followed by the open surgery group and mostly due to the associated severe head injury. TEVAR should be considered for patients requiring intervention unless contraindicated due to technical difficulties. Appropriately selected patients with low-grade injuries may be managed conservatively. Long-term follow-up is needed in young adults for concerns of aortic remodeling and complications.

245 Changing Demographics of Head Injury During the COVID-19 Pandemic

Abstract Introduction Studies have shown that men are more likely to sustain head injuries (HI) due to a higher likelihood of participation in high-risk behaviours. However, the COVID-19 lockdown caused substantial alterations to the daily routines of the Welsh population. We aimed to describe the demographical changes of HI patients caused by this large-scale restriction of public social activity. Method A retrospective review of our neurosurgical referral database was performed between 1/1/19 to 31/12/20 to extract patient demographics and referral outcomes (admission/advice only) of adult head injury patients. Referrals during lockdown in Wales (26/3/20 – 1/6/20 and 31/10/20 and 2/12/20) were compared with non-lockdown periods in 2019 and 2020. Results There was no significant difference in HI referral volume in 2019 (n = 1228) vs 2020 (n = 1179) (OR: 0.71; 95% CI: 0.53 – 0.96, p = 0.02). Women were less likely to be admitted in 2019 (OR: 0.60, 95%CI: 0.39 – 0.91, p = 0.02) and 2020 (OR: 0.52, 95%CI: 0.31–0.88, p = 0.01). We observed evidence of interaction by age and sex in lockdown vs non-lockdown (p = 0.02). Most strikingly, there was higher odds of admission in women aged 40–70 years during lockdown (OR: 10.4, 95%CI: 1.13 – 95.8, p = 0.04). Conclusions We observed significant demographical shifts in HI during lockdown periods, with striking increases in admission rates of men under 40 years and women aged 40–70. The cause of these substantial changes need clarification and have important public health implications. Given likely reduced road traffic accidents during lockdown, other factors such as alcohol or assault need considering.