Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by Abbreviated Injury Score in the Netherlands

Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability. Epidemiology seems to be changing. TBIs are increasingly caused by falls amongst elderly, whilst we see less polytrauma due to road traffic accidents (RTA). Data on epidemiology is essential to target prevention strategies. A nationwide retrospective cohort study was conducted. The Dutch National Trauma Database was used to identify all patients over 17 years old who were admitted to a hospital with moderate and severe TBI (AIS ≥ 3) in the Netherlands from January 2015 until December 2017. Subgroup analyses were done for the elderly and polytrauma patients. 12,295 patients were included in this study. The incidence of moderate and severe TBI was 30/100.000 person-years, 13% of whom died. Median age was 65 years and falls were the most common trauma mechanism, followed by RTAs. Amongst elderly, RTAs consisted mostly of bicycle accidents. Mortality rates were higher for elderly (18%) and polytrauma patients (24%). In this national database more elderly patients who most often sustained the injury due to a fall or an RTA were seen. Bicycle accidents were very frequent, suggesting prevention could be an important aspect in order to decrease morbidity and mortality.

Polytrauma patients with severe cervical spine injuries are different than with severe TBI even though they have similar AIS scores

“…In this study detailed data on TCSI showed that C2 was the most common location of cervical spine fracture, followed by C6-C7. This is in line with other studies [1,4,21]. More than half the patients suffered from complete spinal cord injury with C3-C4 being the most common location for the spinal cord injury.…”

“…Additionally, 9% of patients with severe TCSI had associated severe TBI. The incidence of TCSI and its association with TBI is in accordance with several other reports from literature [1][2][3][4][7][8][9][10].…”

“…In literature, the incidence of cervical spine injury in patients with TBI has been reported up to 13% [7][8][9][10]. Conversely, TBI is frequently associated with cervical spinal injury; the incidence of moderate to severe TBI in patients with cervical spine injury is reported between 18-40% [4,7]. Additionally, recent studies estimated that concurrent TBI in patients with primary traumatic spinal cord injury ranged from 12.5 to 74.2%, based on the diagnostic criteria utilized [11,12].…”

“…Traumatic cervical spinal injuries (TCSI) are a rare entity in the general trauma population. With increasing age however, the incidence of TCSI has increased, and an incidence up to 6.7% has been reported in trauma patients [1][2][3][4]. Additionally, the incidence of moderate to severe traumatic brain injury (TBI) is on the rise [5].…”

Management of traumatic brain injury: practical development of a recent proposal

“…Lastly, polytrauma is common in patients with TBI. 26 Rehabilitation medicine consultants train to manage all injuries (for example, spinal cord injury or complex orthopaedic and musculoskeletal injuries) and any co-existing conditions. Early rehabilitation input is associated with reduced length of stay and other benefits and later the same expert can, for example, support return to work.…”