The Epidemiology of Hospital-Referred Head Injury in Ardabil City

Epidemiology of Traumatic Brain Injury in Iran: A Systematic Review and Meta-Analysis

Background

Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of TBI can be helpful for policy making in health care management. Therefore, this study aimed to examine the epidemiology of TBI in Iran.

Methods

PubMed, Web of Science, Scopus, Google scholar, and internal databases including, SID, Magiran, and IranMedex were searched to identify the relevant published studies up to Feb 2022. Moreover, the references list of key studies was scanned to find more records. The Joanna Briggs Institute (JBI) tool was used to assess the quality of included studies. The Excel and Comprehensive Meta-Analysis software were to analyze the data.

Results

Overall, 23,446 patients from 15 studies were included in the study. The overall mean age of the patients was 31.36 ± 0.13 yr (95%CI: 31.10 to 31.61). The majority of the patients were male (74.37%), with a male to female ratio of 3:1. The incidence rate of TBI was 15.3 to 144 per 100,000 population. The mortality rate of TBI was estimated to be 10.4% (95%CI: 5% to 19%). The most common causes of injury were road traffic accidents (RTAs) (60%; 95%CI: 49% to 70%), and falling (20%; 95%CI: 16% to 26%), respectively. The most frequent type of head injury was subdural hematoma.

Conclusion

Our findings highlight that appropriate control and prevention strategies should be focused on male, road traffic accidents, and the group under 40 yr.

Mild head trauma in elderly patients: experience of an emergency department

INTRODUCTION

We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients.

MATERIAL AND METHODS

We evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography.

RESULTS

We enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The "elderly population" was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001).

CONCLUSIONS

These data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding.

Computed tomography estimation of the prevalence of neuro-ophthalmic injuries in head trauma patients seen in a tertiary health facility in Ghana

INTRODUCTION

Prevalence of traumatic brain injury (TBI) is extremely high and potentially associated with severe incapacitating consequences. Literature reports that 90% of road traffic deaths and injuries including TBI occur in low and middle-income countries including Ghana. Computed Tomography (CT) scan is the imaging modality of choice for the initial assessment of the extent of head injury. Some Neuro-ophthalmic injuries (NOI) may sometimes be ambiguous and indistinct although a serious injury with potential damaging consequences. Data on the prevalence of NOI post trauma is non-existent in Ghana to inform policy. The onus therefore lies on the Radiologist who will review the head CT scan to be very meticulous not to miss any NOI if present. We therefore decided to diligently review a large cross-sectional retrospective post trauma head CT scans for occurrence of NOI.

OBJECTIVE

To determine the incidence of NOI secondary to head trauma and the possible loss of vision thereof in a retrospective study using patients' head CT scan data from a tertiary hospital's CT centre in Cape Coast, Ghana.

METHOD

All head CT scans secondary to trauma for the period January 2016 to December 2018, were retrieved and carefully analysed. A total number of 1043 of head CT scan images were analyzed by Consultant Radiologists.

RESULTS

Results showed out of 1043 CT scans reviewed, 742 (71,1%) were males and 301 (28.9%) were females. A total of 609 (58.4%) out of the 1043 patients sustained NOIs of various anatomical types. More Males 398 (65.4%) sustained NOI than females 211 (34.6%). The incidence of NOI was more among the youth as majority 167 (27.4%) of the patients were within the 18-29 years followed by 30-39 years bracket of 148 (24.3%). Fourteen anatomical types of NOI were elicited and further analysis revealed, intra-ocular foreign body to be the highest 107 (17.6%) cases, orbital floor fractures injury was 92 (15.1%) cases, with globe rupture injury and intraocular hemorrhage recording 79 (13.0%) cases each. Optic nerve injury was the least revealing 7 (1.1%) cases. There was a relationship between the gender of patient and the propensity to sustain NOI as males were more disposed to NOI than females. Road traffic accident (RTA) was the main pervasive cause of TBI and this accounted for 71.9% of all cases, followed by fall from height 24%, and the least cause of TBI was ascribed to gunshot injury of 0.33%.

CONCLUSION

Prevalence of NOI is high. Urgent measures must therefore be implemented to reduce the RTA menace in general and to mitigate the associated NOI and possible loss of vision thereof.

Minor Head Trauma and its Short-term Outcomes Among Elderly Patients: a Prospective Epidemiological Study in North of Iran

Introduction

Traumatic brain injury (TBI) is of the most challenging public health problems.

Aim

The aim of this study was to investigate the epidemiology of mild TBI, frequency of clinically important head injuries identifiable on computed tomography (CT) scans and also short-time outcomes of mild TBI in elderly population in north of Iran.

Patients and Methods

A prospective epidemiological study was conducted at the Emergency department of Imam Khomeini general hospital, Mazandaran, Iran. Inclusion criteria were age older than 60, Glasgow coma scale (GCS) score of 13-15, and a single head trauma. Data were collected by retrospective chart review, interview with patients or their caregivers and contact with them after a week from time of discharge or transferring to another wards.

Results

Response rate was estimated at 67.8% (n: 122/180). Mean age of patients was 65.54±6.42 years. 82% of patients were younger than 70. Mean time from head trauma to hospital admission was 270 minutes. In majority of patients, mechanism of trauma was fall (28%) and then interpersonal violence (25%). 6.6% (95% CI: 2.87 to 12.5%) of patients suffered from important radiologically head injuries and 2.5% (95% CI: 0.5-7.00) were readmitted to hospital within a week.

Conclusion

Time to admission for minor TBI in elderly patients was too long and could be of clinical concern. Considering the lower prevalence of important radiologically head injury among elderly population, using any clinical guideline for indication of CT scan may be more cost-effective than routine use of CT scan. Although short term outcomes of minor TBI were less threatening and not lethal but these patients need follow-up.

Traumatic Brain Injury in Older Adults Presenting to the Emergency Department: Epidemiology, Outcomes and Risk Factors Predicting the Prognosis

Introduction

The continuing-to-grow number of older adults with traumatic brain injury (TBI) presenting to emergency departments (EDs) and hospitals necessitates the investigation of TBI in these patients.

Objective

The present study was conducted to investigate the epidemiology of TBI and the factors affecting intracranial lesions and patient outcomes in older adults.

Method

The present retrospective cross-sectional study was performed between March 2016 and March 2018. The study population comprised all TBI patients with a minimum age of 60 years presenting to the ED. The eligible candidates consisted of patients presenting to the ED within 24 hours of the occurrence of traumas and requiring head CT scan as part of their examination. The patients' baseline information was also recorded.

Results

A total of 306 older adult patients with a mean age of 70.61±8.63 years, of whom 67.6% were male, underwent CT scan for TBI during the study period. Falls were the major cause of head injuries, and intracranial lesions were observed in 22.9% (n=70) of the patients. Subdural hematoma (SDH) was observed as the most prevalent injury in 27.6% of the patients, 22.9% (n=16) were transferred to the operating room, and 7.5% (n=23) died. Moreover, the severity of trauma was significantly different between the two genders (P=0.029). Midline shift, SDH, subarachnoid hemorrhage (SAH) and moderate-to-severe head injuries were also significantly associated with poor outcomes (P<0.05).

Conclusion

Death from TBIs was more likely in the patients with SDH, SAH and midline shift or in those with an initial Glasgow coma scale (GCS) of below 13. These predictions are clinically relevant, and can help improve the management of older adults with TBI.