Traumatismo craneoencefálico en la ciudad de Buenos Aires: estudio epidemiológico prospectivo de base poblacional

Sensitivity and specificity of the INECO frontal screening (IFS) in the detection of patients with traumatic brain injury presenting executive deficits

Executive dysfunction (EF) is a common feature of adult traumatic brain injury (TBI), especially in moderate to severe cases. Assessing EF usually requires the administration of an extensive neuropsychological battery, which is time consuming and expensive. The INECO frontal screening (IFS) is a brief, easy-to-administer screening test which has previously shown to be useful in the detection of executive deficits in different psychiatric and neurological populations. The aim of the present study was to assess the usefulness of the IFS in the detection of executive dysfunction in TBI patients. Twenty-eight TBI patients and thirty-two healthy controls were assessed with a battery that included classical executive tests and the IFS. Our results indicated that with a cutoff score of 26.25 points, the IFS showed good sensitivity and specificity in the detection of executive impairments in TBI patients. It also showed good positive and negative predicted values. Our results suggest that the IFS can be considered a useful tool for identifying executive dysfunction in patients with TBI.

Estimating the global incidence of traumatic brain injury

OBJECTIVE

Traumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.

METHODS

Open-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global Burden of Disease Study 2015 was applied to these two ratios to generate the incidence and estimated case volume of TBI for each WHO region and WB income group.

RESULTS

Relevant articles and registries were identified via systematic review; study quality was higher in the high-income countries (HICs) than in the low- and middle-income countries (LMICs). Sixty-nine million (95% CI 64-74 million) individuals worldwide are estimated to sustain a TBI each year. The proportion of TBIs resulting from road traffic collisions was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). The incidence of RTI was similar in Southeast Asia (1.5% of the population per year) and Europe (1.2%). The overall incidence of TBI per 100,000 people was greatest in North America (1299 cases, 95% CI 650-1947) and Europe (1012 cases, 95% CI 911-1113) and least in Africa (801 cases, 95% CI 732-871) and the Eastern Mediterranean (897 cases, 95% CI 771-1023). The LMICs experience nearly 3 times more cases of TBI proportionally than HICs.

CONCLUSIONS

Sixty-nine million (95% CI 64-74 million) individuals are estimated to suffer TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease. Head injury following road traffic collision is more common in LMICs, and the proportion of TBIs secondary to road traffic collision is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions with higher-quality data, specifically in North America and Europe.

Adolescent injuries in Argentina, Bolivia, Chile, and Uruguay: Results from the 2012-2013 Global School-based Student Health Survey (GSHS)

OBJECTIVES

The goals of this study were to identify the proportion of early adolescents in southern South America who were injured in the past year, to identify risk behaviours and other exposures associated with injuries, and to evaluate the most common types and causes of injury in this population.

METHODS

We used complex samples analysis to examine cross-sectional data from more than 35,000 students from all four countries in South America that participated in the Global School-based Student Health Survey (GSHS) in 2012-2013.

RESULTS

The proportion of students reporting at least one injury in the past year that required medical treatment or caused at least one full day of missed school or usual activities was 27.1% in Argentina, 29.5% in Uruguay, 30.9% in Chile, and 36.8% in Bolivia. Significantly more boys than girls reported injuries. Injured students were more likely than non-injured students to report anxiety-induced insomnia, being physically attacked, being in a physical fight, and being lonely in the past year, and they were also more likely to report being bullied, using tobacco, drinking alcohol, and missing school in the past month. For both boys and girls, the most common type of injury reported was a broken bone or dislocated joint and the most common injury cause was the student falling. However, most students were not able to provide a specific answer to either question.

CONCLUSION

The GSHS has been conducted in 100 low- and middle-income countries and territories around the world, and new waves of data collection are currently being planned and implemented. The utility of the injury data from the GSHS would be improved if the injury type and cause response items were updated to better capture information about self-harm, sports injuries, and other statistics that will provide a stronger foundation for evidence-based injury prevention interventions in adolescent populations.