Incidence and injury characteristics of traumatic brain injury: Comparison between children, adults and seniors in Israel

The epidemiological characteristics of pediatric head injury in Hangzhou, China: a retrospective study based on cranial CT examinations

PRIMARY OBJECTIVE

This study aims to create a pediatric head injury database based on cranial CT examinations and explore their epidemiologic characteristics.

METHODS

Data related to cranial CT examinations of pediatric head injuries from March 2014 to March 2021 were collected at outpatient and emergency department of a pediatric medical center. The causes of injury, observable post-injury symptoms, and cranial injury findings were extracted with the assistance of natural language processing techniques.

RESULTS

Reviewing the data from records on 52,821 children with head injuries over a period of 7 years, the most common causes of pediatric head injury were falls (58.3%), traffic accidents (26.0%), smash/crush/strike (13.9%), violence (1.5%) and sports-related incidents (0.3%). Overall, most of those injured were boys which accounting for 62.2% of all cases. Skull fractures most commonly occur in the parietal bone (9.0%), followed by the occipital (5.2%), frontal (3.3%) and temporal bones (3.0%). Most intracranial hemorrhages occurred in epidural (5.8%), followed by subdural (5.1%), subarachnoid (0.9%), intraparenchymal (0.5%) and intraventricular (0.2%) hemorrhages. Spring and autumn showed more events than any other season.

CONCLUSIONS

To the best of our knowledge, this is the largest sample of epidemiological study of head injury in the Chinese pediatric population to date.

Establishing the Validity of the Internet-Based Bill-Paying Task to Assess Executive Function Deficits Among Adults With Traumatic Brain Injury

IMPORTANCE

Executive function (EF) deficits are common after traumatic brain injury (TBI). During rehabilitation, it is important to identify EF deficits and understand their impact on daily function. The internet-based Bill-Paying Task, modified from the Executive Function Performance Test, has not yet been validated for use with people with TBI.

OBJECTIVE

To examine the known-groups, convergent, and ecological validity of the internet-based Bill-Paying Task for assessing EF deficits after TBI.

DESIGN

Cross-sectional study with two consecutive parts based on the study's objectives.

SETTING

Inpatient rehabilitation and community.

PARTICIPANTS

Part 1 included 42 adults with TBI and 47 healthy adults; Part 2 included 28 of the 42 adults with TBI.

MEASURES

Assessments included the Internet-based Bill-Paying Task, WebNeuro neurocognitive computerized battery, Semantic Verbal Fluency test, Behavioural Assessment of the Dysexecutive Syndrome (BADS), Dysexecutive Questionnaire (DEX), and cognitive items of the FIM® and the Functional Assessment Measure (cognitive FIM+FAM).

RESULTS

For Part 1, participants with TBI required significantly more cues and longer completion time to perform the internet-based Bill-Paying Task. For Part 2, moderate significant correlations were found between the internet-based Bill-Paying Task total score and the WebNeuro, Semantic Verbal Fluency test, BADS, DEX, and cognitive FIM+FAM.

CONCLUSIONS AND RELEVANCE

This study supports the known-groups, convergent, and ecological validity of the internet-based Bill-Paying Task for assessing EF deficits among adults with preserved basic cognitive abilities after TBI. Therefore, it can be used to assist with rehabilitation treatment planning after TBI. What This Article Adds: The internet-based Bill-Paying Task, an online payment task relevant to today's technological world, is valid to assess higher cognitive abilities of people after a traumatic brain injury. This assessment may contribute to a better understanding of patients' cognitive profiles and their potential impact on daily performance.

The Association between Comorbidities and Comorbid Injuries on Treatment Outcome in Pediatric and Elderly Patients with Injuries in Korea: An Observational Study

We aimed to compare the characteristics and types of injuries affecting pediatric and elderly patients and to identify factors associated with treatment outcomes. We used data from the 2006−2017 Korea National Hospital Discharge Survey. The patients were divided into two groups, children (0−12 years) and elderly (≥65 years), based on their age at discharge. In total, 47,528 (11,842 children and 35,686 older adults) patients with injuries were identified. The number of deaths and the LOS were 36 (0.3%) and 7.6 days (±10.1), respectively, in the children group, and 861 (2.4%) and 18.5 days (±27.3), respectively, in the elderly group (p < 0.001). In the children group, there were increased odds for surgery among boys, Medicaid and health insurance subscribers, patients with multiple injuries, patients without a subdiagnosis, and an increasing number of hospital beds. In the elderly group, there were increased odds for surgery among women, Medicaid and health insurance subscribers, patients who died, patients with a single injury, patients with a subdiagnosis, and increasing numbers of hospital beds. Treatment outcomes could be improved by providing early diagnosis and prompt treatment in pediatric patients and by taking multilateral approaches for multiple injuries and comorbidities in elderly patients.

The effects of musical stimulation on the level of consciousness among patients with head trauma hospitalized in intensive care units: A randomized control trial

BACKGROUND

Improvement in the level of consciousness (LOC) is considered as an indicator of recovery among patients with head trauma (HT). musical stimulation is a simple noninvasive intervention with potential positive effects on LOC. This study evaluated the effects of musical stimulation on LOC among patients with HT hospitalized in intensive care unit.

METHODS

This clinical trial was conducted in 2018-2019. Fifty-four patients with HT were purposively and consecutively recruited from two trauma intensive care units in Qazvin, Iran, and randomly allocated to a control (n = 27) and an intervention (n = 27) group. Participants in the intervention group received fifteen-minute musical stimulation once daily for seven consecutive days using an MP3 player and a headphone for their counterparts, the headphones were silent for 15 min without receiving any musical stimulation once daily for seven consecutive days. A demographic questionnaire, the Glasgow Coma Scale, and the Richmond Agitation-Sedation Scale were used for data collection. LOC was daily assessed before and after each musical stimulation session. The SPSS program (v. 23.0) was used for data analysis at a significance level of less than 0.05.

FINDINGS

There were significant between-group differences respecting the posttest mean score of LOC in the third, fourth, fifth, sixth, and seventh days of the study intervention (P < 0.05)., the posttest mean score of LOC in the intervention group significantly increased in the intervention group (P < 0.0001), while it did not significantly change in the control group (P > 0.05).

CONCLUSION

musical stimulation is effective in significantly improving LOC among hospitalized patients with HT. Therefore, it can be used as a non-expensive noninvasive intervention to improve treatment outcomes among these patients.

Traumatic brain injury-the effects of patient age on treatment intensity and mortality

Background

Ageing is associated with worse treatment outcome after traumatic brain injury (TBI). This association may lead to a self-fulfilling prophecy that affects treatment efficacy. The aim of the current study was to evaluate the role of treatment bias in patient outcomes by studying the intensity of diagnostic procedures, treatment, and overall 30-day mortality in different age groups of patients with TBI.

Methods

Included in this study was consecutively admitted patients with TBI, aged ≥ 15 years, with a cerebral CT showing intracranial signs of trauma, during the time-period between 2015–2018. Data were extracted from our prospective quality control registry for admitted TBI patients. As a measure of management intensity in different age groups, we made a composite score, where placement of intracranial pressure monitor, ventilator treatment, and evacuation of intracranial mass lesion each gave one point. Uni- and multivariate survival analyses were performed using logistic multinomial regression.

Results

A total of 1,571 patients with TBI fulfilled the inclusion criteria. The median age was 58 years (range 15–98), 70% were men, and 39% were ≥ 65 years. Head injury severity was mild in 706 patients (45%), moderate in 437 (28%), and severe in 428 (27%). Increasing age was associated with less management intensity, as measured using the composite score, irrespective of head injury severity. Multivariate analyses showed that the following parameters had a significant association with an increased risk of death within 30 days of trauma: increasing age, severe comorbidities, severe TBI, Rotterdam CT-score ≥ 3, and low management intensity.

Conclusion

The present study indicates that the management intensity of hospitalised patients with TBI decreased with advanced age and that low management intensity was associated with an increased risk of 30-day mortality. This suggests that the high mortality among elderly TBI patients may have an element of treatment bias and could in the future be limited with a more aggressive management regime.

Comparison between traumatic brain injury with and without concomitant injuries: an analysis based on a national trauma registry 2008-2016

Objective: To compare demographic, injury and hospitalization characteristics and mortality between Isolated and Non-Isolated traumatic brain injury.Methods: A retrospective study based on the Israeli National Trauma Registry of patients hospitalized for traumatic brain injury (TBI) between 2008 and 2016. Isolated TBI was defined as no other anatomic region was having concomitant injury with AIS ≥2. X2 test and multivariate logistic regression analysis were used for data analysis.Results: Of the 23566-study population, 40.4% were admitted for isolated TBI. Isolated TBI was significantly more frequent in elderly aged ≥65 years, female, Jews, and injuries sustained at home or in residential institution. The Non-isolated TBI was greater in road traffic injuries, particularly among pedestrians and motor cyclists, and in violence injuries. The Non-isolated TBI group had greater injury severity and hospital resource utilization. In-hospital mortality was higher in the patients with Non-isolated TBI [OR: 1.56(95% CI: 1.33-1.83)], particularly in patients with GCS 13-15; elderly aged 65+ years; and patients with concomitant injuries to abdomen, spine or external body regions.Conclusion: In a patient with TBI, concomitant injuries with AIS ≥2 matter, and awareness of the identified factors has relevance for guiding injury prevention efforts and indeed for potentially improving care and outcome.

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.

Procedural sedation in non-intubated children with severe trauma - A single center study

BACKGROUND

Non-intubated children frequently undergo emergent procedures in the trauma-bay. This study evaluates whether patients treated with procedural sedation have an increased risk for severe adverse events.

METHODS

Retrospective analysis of 1182 children with an injury severity score (ISS) of greater than 15.

RESULTS

Of the 565 patients who were spontaneously breathing on arrival, 455 were hemodynamically stable with a Glasgow Coma Score of 15, 201 of whom were treated with sedation; 144 (71.6%) had computerized tomography scan, 35 (17.5%) wound debridement, and 22 (10.9%) fracture reduction. Sedation patients had an ISS of 20 (interquartile range 17-25). There were no death cases, no cases of cardiopulmonary resuscitation, and no cases of neurologic sequelae on hospital discharge. There were 2 (1%) cases of unanticipated endotracheal intubation.

CONCLUSIONS

Non-intubated patients who were hemodynamically stable with a Glasgow Coma Score of 15 had a low risk for severe adverse events due to sedation.

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

BACKGROUND Traumatic 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 AND METHODS Data 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. RESULTS Among 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. CONCLUSIONS Patients with traumatic HI show remarkable differences in clinicopathological features among juvenile, middle-aged, and elderly individuals.

Interrater Reliability of Three Versions of the Chedoke Arm and Hand Activity Inventory

Purpose: The purpose of this study was to estimate the interrater reliability of three shortened versions of the Chedoke Arm and Hand Activity Inventory (CAHAI-7, CAHAI-8, CAHAI-9) when used with persons with acquired brain injury (ABI). The CAHAI is an assessment of upper limb function with high reliability in the stroke and ABI populations. In the stroke population, three shortened versions of the measure have established reliability. Clinicians report time constraints as a barrier to using standardized assessments; thus, establishing the reliability of the shortened versions of the CAHAI in the ABI population may increase the use of this measure. Method: This was an observational, parameter estimation study. The participants were recruited from an in-patient ABI rehabilitation programme. The administration of the CAHAI to six persons with ABI was video recorded, and the video recordings were assessed by six clinicians to estimate interrater reliability. A Latin square design was used to balance the order in which the raters evaluated the videos. A repeated-measures analysis of variance was performed, and the variance components were used to calculate an intra-class correlation coefficient (ICC) and standard error of measurement (SEM) with 95% confidence limits (CLs) for each of the shortened versions. Results: Interrater reliability was high for all three versions: CAHAI-7, ICC=0.96 (95% CL: 0.89, 0.99; SEM 2.65); CAHAI-8, ICC=0.96 (95% CL: 0.90, 0.99; SEM 2.72); and CAHAI-9, ICC=0.95 (95% CL: 0.85, 0.99; SEM 3.49). Conclusions: These results suggest that the three shortened versions of the CAHAI demonstrate high reliability in the ABI population. These versions may be particularly useful when time constraints or patient tolerance are an issue.

"Shared Destiny": The Dynamics of Relationships in Families of Patients With Brain Injury

This qualitative research focused on the relationships between family members of patients with acquired brain injury (ABI). The aim was to explore the dynamics between caregivers of the family member with a brain injury during rehabilitation hospitalization, and the relationships between them and the rest of the extended family. Twenty semistructured interviews were conducted with family members. In each family, the spouse of the patient and another family member involved in caregiving were interviewed. The importance of the relationships between family members during rehabilitation hospitalization justifies the examination undertaken in this research. Findings point at the change that took place in the relationships between family members because of the need to cope with a relative's injury. It is possible that direct intervention in the dynamics of the relationship, especially between the family of origin and the nuclear family of the injured person, can benefit extended families in coping with the crisis.