Traumatic Brain Injury In China Research Articles

Epidemiological Characteristics of Older Patients with Traumatic Brain Injury in China.

Increasing traumatic brain injury (TBI) among older adults constitutes a substantial socioeconomic burden, in step with the growing aging global population. Here, we aimed to investigate the profile of geriatric TBI in the CENTER-TBI China registry, a prospective observational study conducted in 56 centers of 22 provinces across China. Patients admitted to the hospital with a clinical diagnosis of TBI were enrolled in the study. Data on demographic characteristics, injury, clinical features, treatments, and survival at discharge were collected and assessed. The primary end point was survival state at discharge. We analyzed a total of 2415 patients aged ≥65 years, accounting for 18.34% of the overall population. The median age was 72 years (interquartile range [IQR]: 68-78), and 1588 (65.76%) were men. Incidental falls (n = 1044, 43.23%) were the leading cause of TBI, followed by road traffic injuries (n = 1034, 42.82%). Roads and homes were the main sites of injury. The median Glasgow Coma Scale (GCS) score was 13 (IQR: 9-15); 1397 (57.85%) patients had mild TBI (GCS 13-15), while 530 (21.95%) and 488 (20.21%) presented with moderate (GCS 9-12) and severe TBI (sTBI; GCS 3-8), respectively. A total of 546 (22.61%) patients underwent intracranial surgery. The overall in-hospital mortality rate was 8.24% (n = 199), and most survivors were transferred home. This study revealed that the demographic patterns and injury mechanisms are changing among elderly patients with TBI in China. More attention should be given to the high incidence of geriatric TBI to improve prevention and management strategies.

Correlation between vitamin D and cognitive function in patients with traumatic brain injury in China

Objective This study investigated changes in vitamin D levels in traumatic brain injury (TBI) patients and the relationship between vitamin D levels and cognitive function. Methods Thirty-five TBI patients in our hospital were randomly selected, and baseline data were collected. 25-Hydroxyvitamin D (25(OH)D) plasma levels were determined within a month of hospitalization, and awareness and cognitive function were assessed using the Glasgow Coma Scale (GCS) and the Mini Mental State Examination (MMSE), respectively, on the day of blood collection. The data were statistically analyzed. Results The MMSE and GCS scores were positively correlated (p < 0.05); higher MMSE scores were associated with higher GCS scores. Moreover, the total score was positively correlated with directional ability, memory, and attention, suggesting high internal consistency of the MMSE score, but no significant correlation with other indicators was observed. 25(OH)D was positively correlated with the injury site (p < 0.05), suggesting that frontal damage has a significant impact on the plasma level of 25(OH)D. Conclusion The plasma vitamin D level in TBI patients may indicate frontal lobe damage. The overall plasma level of 25(OH)D in TBI patients was not significantly correlated with cognitive function, but the incidence of cognitive impairment was higher with 25(OH)D level between 10 and 30 ng/ml.

Global traumatic brain injury research enters a new era.

Traumatic brain injury (TBI) remains a substantial medical and socioeconomic challenge worldwide, and reliable data on epidemiology, care pathways, and outcomes are still lacking because of heterogeneity in definitions, data collection, and reporting. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (874) Google Scholar The pan-European Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) study 2 Maas AI Menon DK Steyerberg EW et al. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery. 2015; 76: 67-80 Crossref PubMed Scopus (276) Google Scholar , 3 Steyerberg EW Wiegers E Sewalt C et al. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol. 2019; 18: 923-934 Summary Full Text Full Text PDF PubMed Scopus (143) Google Scholar paves the way for large-scale collaborative studies on TBI across continents, using common definitions and harmonised data collection. 2 Maas AI Menon DK Steyerberg EW et al. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery. 2015; 76: 67-80 Crossref PubMed Scopus (276) Google Scholar In The Lancet Neurology, Guoyi Gao and colleagues report the results of the Chinese sister study—the CENTER-TBI China registry study including 13 138 patients from 52 centres. 4 Gao G Wu X Feng J et al. Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicenter, longitudinal, observational study. Lancet Neurol. 2020; 19: 670-677 Summary Full Text Full Text PDF Scopus (25) Google Scholar For the first time, clinical data of TBI in China have been collected in a format that is compatible with standardised common data elements and identical inclusion criteria. Despite limitations—eg, data collection restricted to patients in neurointensive care or preselected neurosurgical centres and to outcome at discharge only—the results can be considered as representative of how care for patients with TBI is delivered in China today. The study covered two-thirds of all Chinese provinces and had a median enrolment of 137 patients per centre (IQR 51–346; appendix). Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicentre, longitudinal, observational studyThe results show differences in mortality between centres and regions across China, which indicates potential for identifying best practices through comparative effectiveness research. The risk factors identified in prognostic analyses might contribute to developing benchmarks for assessing quality of care. Full-Text PDF

Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicentre, longitudinal, observational study.

Large-scale studies are required to better characterise traumatic brain injury (TBI) and to identify the most effective treatment approaches for TBI. However, evidence is scarce and mostly originates from high-income countries. We aimed to describe the existing care for patients with TBI and the outcomes in China. The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) China registry is a prospective, multicentre, longitudinal, observational study done in 56 neurosurgical centres across China. We collected data of patients who were admitted to hospital with a clinical diagnosis of TBI and an indication for CT. Patients who were discharged directly from the emergency room were excluded. The primary endpoint was survival on discharge. Prognostic analyses were applied to identify predictors of mortality. Variations in mortality were compared between centres and provinces within China. Mortality was compared with expected mortality, estimated using the CRASH basic model. This study was registered with ClinicalTrials.gov, NCT02210221. From Dec 22, 2014, to Aug 1, 2017, 13 627 patients with TBI from 56 centres were enrolled in the registry. Data from 13 138 patients from 52 hospitals in 22 provinces of China were analysed. Most patients were male (9782 [74%]), with a median age of 48 years (IQR 33-61). The median Glasgow Coma Scale (GCS) score was 13 (IQR 9-15), and the leading cause of injury was road-traffic incident (6548 [50%]). Overall, 637 (5%) patients died, including 552 (20%) patients with severe TBI. Age, GCS score, injury severity score, pupillary light reflex, CT findings (compressed basal cistern and midline shift ≥5 mm), presence of hypoxia, systemic hypotension, altitude higher than >500 m, and GDP per capita were significantly associated with survival in all patients with TBI. Variation in mortality existed between centres and regions. The expected 14-day mortality was 1116 (13%), but 544 (7%) deaths within 14 days were observed (observed to expected ratio 0·49 [95% CI 0·45-0·53]). The results show differences in mortality between centres and regions across China, which indicates potential for identifying best practices through comparative effectiveness research. The risk factors identified in prognostic analyses might contribute to developing benchmarks for assessing quality of care. None.

Prevalence and Altered Causes of Traumatic Brain Injury in China: A Nationwide Survey in 2013

Background: Traumatic brain injury (TBI) is one of the leading causes of death and disability annually worldwide. However, the epidemiology of TBI had not been established in China. We conducted a nationally representative door-to-door survey in the general population across all age groups in 31 provinces in mainland China in 2013. Methods: All participants were reviewed for a history of physician-diagnosed TBI by trained investigators using a structured questionnaire. TBI survivors were considered as prevalent cases at the prevalent time. The present study also examined the odds of TBI as a function of sex, age, and other demographical variables using logistic regression model. Results: Of 583,870 participants, 2,673 individuals had suffered from a TBI during their past life, yielding a weighted prevalence of being 442.4 (95% CI 342.2–542.6) per 100,000 person. The TBI prevalence increased with increasing age. The present study observed the multiadjusted ORs of TBI were 1.9 (95% CI 1.8–2.1) for the male, 1.9 (95% CI 1.2–3.1) for the farmers, 1.9 (95% CI 1.2–3.3) for the retiree or homemakers, 3.4 (95% CI 1.5–7.7), and 2.8 (95% CI 1.1–6.6) for those whose education were primary school and high school, respectively. The most common external cause was road traffic accidents among those who were aged 18–34 years old and those whose educational levels were middle school in both genders. Conclusions: Our results indicate TBI was substantially prevalent among Chinese population and underscore the need to develop national strategies to improve the safe education on road and traffic of TBI in rural residents and some subgroup population.

Preliminary study of the validity and reliability of the Chinese version of the Saint Louis University Mental Status Examination (SLUMS) in detecting cognitive impairment in patients with traumatic brain injury

The Saint Louis University Mental Status Examination (SLUMS) has been shown to be useful in the cognitive assessment in older adults and patients with dementia. The aim of this study was to preliminarily explore the effectiveness of the Chinese version of the SLUMS in the detection of cognitive impairment in patients with traumatic brain injury (TBI) and to provide an objective basis for its clinical application in China. In this cross-sectional study, 42 patients with TBI and 30 matched normal controls were administered. Participants were assessed by the Chinese version of the Mini-Mental State Assessment scale (MMSE), Montreal Cognitive Assessment scale (MoCA) and SLUMS. Results showed that the Chinese version of the SLUMS had satisfactory internal consistency (Cronbach's α coefficient: 0.723), excellent interrater reliability (ICC: 0.990–0.998) and intrarater reliability (ICC: 0.968), as well as good validity. In the TBI group, the total SLUMS score was moderately positively correlated with the MMSE score (r = 0.702, p = .000) and highly positively correlated with the MoCA score (r = 0.831, p = .000). Receiver Operating Characteristic (ROC) curve analyses showed that the area under the curve (AUC) of the SLUMS, MMSE and MoCA were 0.872, 0.756 and 0.916, respectively. The optimal cutoff score of 22.5 or fewer points are suggested for the SLUMS to discriminate cognitive impairment, with a sensitivity of 0.844 and a specificity of 0.825. The Chinese version of the SLUMS has excellent reliability and validity, and can be used as a screening tool for cognitive impairment of patients with TBI in China.

The long journey towards uniform epidemiological monitoring of TBI around the globe

Reliable epidemiological data and improved awareness of traumatic brain injury (TBI) are both essential to fully understand the scale and socioeconomic burden of this condition, including our ability to plan and implement prevention measures, and to allocate health-care resources. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar Although accomplishing these tasks, at first glance, might be considered straightforward, reality has proven the contrary. To date, all attempts to harmonise data collection and analyses across Europe and USA still confirm wide variation and discrepancies in reported incidence and mortality. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar , 2 Li M Zhao Z Yu G Zhang J Epidemiology of traumatic brain injury over the world: a systematic review. Austin Neurol & Neurosci. 2016; 1: 1007 Google Scholar , 3 Majdan M Plancikova D Brazinova A et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016; 1: e76-e83 Summary Full Text Full Text PDF PubMed Scopus (228) Google Scholar These differences are mostly attributable to methodological diversity, including differences in case ascertainment, non-standardised definitions of TBI, and variations in hospital admission policies. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar , 2 Li M Zhao Z Yu G Zhang J Epidemiology of traumatic brain injury over the world: a systematic review. Austin Neurol & Neurosci. 2016; 1: 1007 Google Scholar , 3 Majdan M Plancikova D Brazinova A et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016; 1: e76-e83 Summary Full Text Full Text PDF PubMed Scopus (228) Google Scholar Moreover, robust data for many parts of the world, particularly for low-to-middle-income countries (LMICs) where TBI is likely to occur much more frequently, are almost entirely absent. Traumatic brain injury in ChinaChina has more patients with traumatic brain injury (TBI) than most other countries in the world, making this condition a major public health concern. Population-based mortality of TBI in China is estimated to be approximately 13 cases per 100 000 people, which is similar to the rates reported in other countries. The implementation of various measures, such as safety legislation for road traffic, establishment of specialised neurosurgical intensive care units, and the development of evidence-based guidelines, have contributed to advancing prevention and care of patients with TBI in China. Full-Text PDF

Production of main concepts by Mandarin-speakers with traumatic brain injury in China: A pilot study

Event Abstract Back to Event Production of main concepts by Mandarin-speakers with traumatic brain injury in China: A pilot study Glen Ning Gao1, Anthony Pak Hin Kong2* and Kai-Yan Dustin Lau1 1 The Polytechnic University of Hong Kong, Hong Kong, SAR China 2 University of Central Florida, United States Background According to Zhao and Wang (2001), traumatic brain injury (TBI) is a great public health concern in Mainland China with incidence rates of 55 and 64 per 100,000 as well as mortality rates of 6.3 and 9.7 per 100,000 in urban and rural areas of China, respectively. To provide proper management of communication disorders in TBI cases in China, valid assessment tools are required. Motivated by Nicholas and Brookshire (1995) and considering the cultural and linguistic differences between English and Chinese, Kong (2009, 2011) has developed a clinically oriented assessment of aphasia discourse focusing on main concept analysis (MCA) for Cantonese speakers. Specifically, the MCA evaluates the degree of presence, accuracy, and completeness of concepts produced and a speaker’s efficiency of the production. Aim The aims of this pilot study were to (1) examine how well the MCA can be applied to Mandarin-speaking TBI clients in Mainland China and (2) investigate how MCA performance varied as a function of severity of language impairment and cognitive deficits in TBI. Methods Seventeen TBI clients (12 male + 5 female; mean age of 39.7 years) were recruited and described four sets of sequential pictures (previously designed for MCA by Kong). The main concepts within the language samples were tallied for each speaker and each of them was categorized as (i) Accurate and Complete – AC, (ii) Accurate but Incomplete – AI, (iii) Inaccurate – IN, or (iv) Absent – AB. A composite Main Concept Score (calculated by “3×AC+2×AI+1×IN”) and an efficiency measure of AC per minute were then computed. Each of the subjects was also administered the Mandarin version of the Western Aphasia Battery (MAB; Peking University Health Science Center, 1988) to estimate their language impairment as well as the Mandarin adaptation of the Cognitive Linguistic Quick Test (CLQT; Helm-Estabrooks, 2001) to reflect their deficits across different cognitive domains. Results As shown in Table 1, the severity of language impairment significantly affected our subjects’ performance on the MCA measures of AC, AB, MC Score, and AC per minute. Based on the results of the MAB, five and 12 subjects were diagnosed with fluent and non-fluent aphasia, respectively. An independent-sample t-test for between-group analyses of the MC Score revealed significant differences of the two fluency groups (t=2.655, p<0.05). The significant correlations between MC Score and CLQT subtests also indicated the subjects’ ability to perform a discourse task could potentially be affected by various cognitive domains, including attention (e.g., symbol cancellation), memory (e.g., personal facts and design memory), visuospatial (e.g. design generation), and executive function (e.g., clock drawing). Conclusion and Further Directions The preliminary results suggested that the MCA is sensitive in reflecting the language and cognitive impairments among speakers with TBI. The score distributions indicated that the tool is also culturally suitable for use in native Mandarin speakers in Mainland China. Additional analyses involving comparison between TBI and control groups as well as examination of the effect of age and education level on main concept production are in progress. Figure 1 Acknowledgements Special thanks to Dr. Jie Zhu and clinicians in the Speech Therapy Department of the Guangdong Work Injury Rehabilitation Hospital (Guangzhou, China) for their help in subject recruitment and testing. References Kong, A. P. H. (2009). The use of main concept analysis to measure discourse production in Cantonese-speaking persons with aphasia: A preliminary report. Journal of communication disorders, 42(6), 442-464. Kong, A. P. H. (2011). The main concept analysis in Cantonese aphasic oral discourse: External validation and monitoring chronic aphasia. Journal of Speech, Language, and Hearing Research, 54(1), 148-159. Helm-Estabrooks, N. (2001). Cognitive Linguistic Quick Test. San Antonio, TX: Pearson. Peking University Health Science Center (PUHSC) (1988). Mandarin aphasia battery. Unpublished work. Zhao, Y. D., & Wang, W. (2001). Neurosurgical trauma in People's Republic of China. World journal of surgery, 25(9), 1202-1204. Keywords: Main concepts, TBI, discourse, Mandarin Chinese, Cognition Conference: 54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016. Presentation Type: Poster Sessions Topic: Student Submissions Citation: Gao G, Kong A and Lau K (2016). Production of main concepts by Mandarin-speakers with traumatic brain injury in China: A pilot study. Front. Psychol. Conference Abstract: 54th Annual Academy of Aphasia Meeting. doi: 10.3389/conf.fpsyg.2016.68.00005 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 17 Apr 2016; Published Online: 15 Aug 2016. * Correspondence: Dr. Anthony Pak Hin Kong, University of Central Florida, Orlando, United States, akong@hku.hk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Glen Ning Gao Anthony Pak Hin Kong Kai-Yan Dustin Lau Google Glen Ning Gao Anthony Pak Hin Kong Kai-Yan Dustin Lau Google Scholar Glen Ning Gao Anthony Pak Hin Kong Kai-Yan Dustin Lau PubMed Glen Ning Gao Anthony Pak Hin Kong Kai-Yan Dustin Lau Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Epidemiology of Traumatic Brain Injury over the World: A Systematic Review

We identified 60 reports from 29 countries with data on Traumatic brain injury (TBI) epidemiology in the published literature. Men were at higher risk of TBI than women. The average age at the time of TBI ranged from 27 to 59.67 years while the median age ranged from 29 to 45 years. The incidence of TBI in Sweden, Italy and Norway was decreased while the incidence of TBI in Spain and Taiwan was increased. The countries with the incidence of TBI from high to low were New Zealand, United States, Spain, Sweden, South Africa, Austria, France, Italy, Germany, Canada, Norway, Australia, Portugal, Finland, China, Iran, Switzerland and Belgium. The overall mild: moderate: severe ratio was 55: 27.7: 17.3 based on Glasgow Coma Scale (GCS). In patients with moderate and severe TBI, death was the most common outcome. In TBI patients with all severities, good recovery was the major clinical outcome. Motor vehicle collision (MVC) was the leading cause of TBI in China, Pakistan, Japan, Australia, France, Spain, Austria, England, Croatia, Slovakia, Bosnia, Macedonia, Netherland and Italy, whereas fall was the leading cause in United States, Canada, New Zealand, Sweden, Scotland, Norway and Finland. The MVC-related TBIs were the most common causes in developing countries, whereas the fall-related TBIs were the most common causes in developed countries. The percentage of MVC-related TBIs was the highest in Asia. Europe had the highest percentage of fall-related TBIs and work-related TBIs. North America, followed by Oceania, had the highest percentage of sport-related TBIs.

Incidence of Headache After Traumatic Brain Injury in China: A Large Prospective Study

There have yet to be any large-scale studies in China on headaches after traumatic brain injury (TBI). We evaluate the incidence of headache after TBI and investigate risk factors and functional outcome in a large tertiary center with a high caseload. A total of 543 patients (82% men, 18% women) with a mean age of 48.4 ± 18.6 years presenting with TBI were prospectively enrolled in this study between March 2011 and July 2013. Patient demographics, severity of TBI, incidence and classification of headache, and treatment information were collected during initial hospitalization and at 3, 6, and 12 months follow-up. Of our 543 patients (82% men, 18% women), 62% were injured in motor vehicle collisions and 27% in falls. Most patients (97%) were considered to have mild TBI. Follow-up rates at 3, 6, and 12 months were 91%, 75%, and 61%, respectively. Only 12% of patients reported pre-TBI headaches, whereas 58% of respondents reported headache at 3 months follow-up, 54% at 6 months follow-up, and 49% at 1 year follow-up. No statistically significant correlations between age, sex, or TBI severity and posttraumatic headaches were observed. We present the findings of the first study on headaches after TBI in China. Headaches were found to occur in most patients with TBI and persisted through the first year after injury. The incidence of posttraumatic headache observed here is comparable with previously published studies outside China.

Clinical Practice Experiences in Diagnosis and Treatment of Traumatic Brain Injury in Children: A Survey among Clinicians at 9 Large Hospitals in China.

Proper diagnosis and treatment of traumatic brain injury (TBI) in children is becoming an increasingly problematic issue in China. This study investigated Chinese clinicians to provide information about their knowledge and experiences in diagnosis and treatment of pediatric TBI. We conducted a questionnaire survey among clinicians in the emergency departments and neurosurgery departments at 9 major hospitals in China. The questionnaire included demographic information, and knowledge and experiences regarding the diagnosis and treatment of pediatric TBI. A total of 235 clinicians completed questionnaires. 43.8% of the surveyed clinicians reported children with only scalp hematoma without any other signs and symptoms of concussion as TBI cases. Most clinicians (85.1%) reported no existing uniform diagnostic criteria for children with TBI in China. The majority of clinicians (91.9%) reported that CT scans were performed in all patients with suspected head injury as a routine procedure in their hospitals. Only 20.9% of clinicians believed that radiation from CT scanning may increase cancer risk in children. About 33.6% of the clinicians reported that they ordered CT scans to investigate suspected head injury due to the poor doctor-patient relationship in China, and to protect themselves against any medical lawsuits in the future. About 80% of the clinicians reported that there are no existing pediatric TBI treatment guidelines in China. Instead a senior doctor’s advice is the most reported guidelines regarding treating pediatric TBI (66.0%). All of the surveyed clinicians reported that the lack of diagnosis and/or treatment standard is the biggest problem in effectively diagnosing and treating pediatric TBI in China. Developing guidelines for the diagnosis and treatment of children with TBI is a high priority in China. The extremely high usage of CT for pediatric TBI in China suggests that it is important to establish evidence-based clinical decision rules to help Chinese clinicians make diagnostic and therapeutic decisions during their practice in order to identify children unlikely to have a clinically-important TBI who can be safely discharged without a CT scan.

Mild-to-Moderate Hypothermia for Management of Severe Traumatic Brain Injury in China: History, Current Status, and Future.

Mild-to-Moderate Hypothermia for Management of Severe Traumatic Brain Injury in China: History, Current Status, and Future.

Geriatric Traumatic Brain Injury in China

Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality in China. The elderly population has the higher rates of TBI-related hospitalization and death. Traffic accidents are the major cause for TBI in all age groups except in the group of 75 years and older, in which stumbles occurred in nearly half of those who suffered TBI. Older age is known to negatively influence outcome after TBI. To date, investigators have identified a panel of prognostic factors that include initial Glasgow Coma Scale score, comorbidities, cerebrospinal fluid leakage, associated extracranial lesions, and other factors such as cerebral perfusion pressure on recovery after injury. However, these aspects remain understudied in elderly patients with TBI. In the absence of complete clinical data, predicting outcomes and providing good care of the elderly population with TBI remain limited. To address this significant public health issue, a refocusing of research efforts is justified to prevent TBI in this population and to develop unique care strategies for achieving better clinical outcomes of the patients with TBI.

Epidemiology of Traumatic Brain Injury in Eastern China, 2004: A Prospective Large Case Study

Traumatic brain injury (TBI) is the leading cause of death for traumatic injury, which is the fifth highest killer in China and the highest killer in adults under 40 years of age. But, there is a lack of epidemiologic data of TBI in China during the past decade. This study aimed to investigate the epidemiologic data of TBI in eastern China, based on a prospective multicenter trial. Data were collected from the 77 hospitals by standardized structured questionnaires in this region during the 1-year period (2004). A total of 14,948 of cases of traumatic brain injury were identified from 77 hospitals in eastern China. There were 11,446 men (76.6%) and 3,502 women (25.4%). Male adolescents and young adults were affected more often by brain injury. Traffic accidents (60.9%), knock on head (13.4%), and falls (13.1%) were the leading causes of patients with TBI. Approximately one-thirds of the traffic-related TBI were motorcyclists, 31% were pedestrians, and 21.9% were cyclists, whereas motor vehicle occupants only counted for 14% of the cases. The distribution of head injury severity, on the basis of Glasgow Coma Scale scores, was mild in 62%, moderate in 18.1%, and severe in 20% for all cases. The traffic accidents caused the most of severe injuries, which accounted for about 70.4%. Based on Glasgow Outcome Scale assessment, 10.8% of the patients died, 2.6% were in vegetation status, 2.2% had severe disability, 7.2% had moderate disability, and 77.3% had good recovery. And, the outcome depended on age, injury mechanism and initial Glasgow Coma Scale score. The prospective cohort study shows an alteration of TBI during the past decade in eastern China. It is essential to establish a standardized surveillance system of TBI incidence, risk factors, causes, and outcomes for development of new, more effective, targeted strategies to prevent TBI.