Increasing incidence of pediatric mild traumatic brain injury in Finland – a nationwide register study from 1998 to 2018

Kuitunen, Ilari; Ponkilainen, Ville; Iverson, Grant L.; Isokuortti, Harri; Luoto, Teemu; Mattila, Ville M.

doi:10.1016/j.injury.2022.12.023

Cited by 7 publications

(9 citation statements)

References 27 publications

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“…In the Finnish pediatric population, the incidence of diagnosed pTBIs during a 21-year retrospective cohort study (1998–2018) was 332 per 100,000 person-years [ 25 ]. In our study, the cumulative incidence of acute neurosurgeries for these injuries was 1.47 per 100,000 person-years, which is 1.5% of all pTBIs in Finland.…”

Section: Discussionmentioning

confidence: 99%

“…The most common type of hospitalized pTBI is mild, accounting for at least 81% of pTBI [ 6 , 10 , 11 ]. Studies have reported increasing incidences of mild pTBI in Finland from 1998 to 2018 as well as in the USA from 2002 to 2012 [ 16 , 25 , 35 ]. However, also, decreasing incidences of mild pTBI have been reported [ 6 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of acute neurosurgery for traumatic brain injury in children—a nationwide analysis from 1998 to 2018

et al. 2023

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Background Most of moderate and severe pTBIs are managed conservatively, but in some cases neurosurgical interventions are needed. The incidence rates of acute pTBI neurosurgery vary considerably between countries and operation types. Our goal was to assess the incidence of acute pTBI neurosurgery in Finland. Methods We conducted a retrospective Finnish register-based cohort study from 1998 to 2018. We included all patients that were 0 to 17 years of age at the time of the TBI. The incidence rates of patients with pTBI undergoing neurosurgery and the rates for specific operation types were calculated per 100,000 person-years. We compared the annual incidences with incidence rate ratios (IRR) with 95% confidence intervals (CI). We stratified patients to three age categories: (i) 0 to 3 years of age, (ii) 4 to 12 years of age, and (iii) 13 to 17 years of age. Results The total number of neurosurgeries for acute pTBI during the study period was 386, and the cumulative incidence was 1.67 operations per 100,000 person-years. The cumulative incidence during the 21-year follow-up was highest at the age of 16 (IRR 4.78, CI 3.68 to 6.11). Boys had a 2.42-time higher cumulative incidence (IRR 2.35, CI 1.27 to 3.99) than girls (IRR 0.97, CI 0.35 to 2.20). The most common neurosurgery was an evacuation of an intracranial hemorrhage (n = 171; 44.3%). Conclusion The incidence of neurosurgeries for pTBIs has been stable from 1998 to 2018. The incidence was highest at the age of 16, and boys had higher incidence than girls.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of acute neurosurgery for traumatic brain injury in children—a nationwide analysis from 1998 to 2018

et al. 2023

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“…5 A Finnish cohort study of 290 patients with pTBI who were treated in intensive care units reported that the incidence of PTE was 20% and the median time to antiseizure medication purchases for epilepsy after TBI was 125 days. Those patients later diagnosed with clinical epilepsy underwent more intensive management (27% vs. 5%), and patients with low Glasgow Coma Scale scores [3][4][5][6][7][8] had higher odds for developing PTE. 22 Adult PTE is a more widely studied subject, and the estimation of PTE is between 3% and 5% after moderate TBI and between 25% and 50% after severe TBI.…”

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confidence: 99%

Association between pediatric traumatic brain injury and epilepsy at later ages in Finland: A nationwide register‐based cohort study

Laaksonen,

Ponkilainen,

Kuitunen

et al. 2023

Epilepsia

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ObjectiveTo examine how pediatric traumatic brain injury (pTBI) correlated with incidence of epilepsy at later ages in Finland.MethodsA nationwide retrospective register‐based cohort study from 1998 to 2018. The study group consisted of 71 969 pediatric (<18 years) patients hospitalized with TBI and a control group consisting of 64 856 pediatric patients with distal extremity fracture. Epilepsy diagnoses were gathered from the Finnish Social Insurance Institution. Kaplan‐Meier (KM) and multivariable Cox regression models were conducted to analyze the probability of epilepsy with 95% confidence intervals (CI).ResultsCumulative incidence rates (CIR) for the first 2 years were 0.5% in the pTBI group and 0.1% in the control group. The corresponding rates after 15 years of follow‐up were 1.5% in the pTBI group and 0.7% in the control group. Due to proportional hazard (PH) violations, the study population was split to the first 2 years and in subgroup analysis 4 years. During the first 2 years of surveillance, the hazard ratio (HR) for the pTBI group was 4.38 (CI: 3.39‐5.66). However, between years 2 and 20, the HR for the pTBI group was 2.02 (CI: 1.71‐2.38). A total of 337 patients (0.47%) underwent neurosurgery and 36 (10.7%) patients subsequently developed epilepsy. The CIR for the first year after TBI were 4.5% (CI: 2.3‐6.7%) in operatively managed patients and 0.3% (CI: 0.3‐0.4%) in non‐operatively managed patients. Corresponding figures after 15 years were 12.0% (CI: 8.2‐15.8%) and 1.5% (CI: 1.4‐1.6%). During the first 4 years of surveillance, the HR for the operative pTBI group was 14.37 (CI: 9.29‐20.80) and 3.67 (CI: 1.63‐8.22) between years 4 and 20.SignificancepTBI exposes patients to a higher risk for posttraumatic epilepsy (PTE) for many years after initial trauma. Children who undergo operative management for TBI have a high risk for epilepsy, and this risk was highest during the first 4 years after injury.

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“…Boys are notably over represented in the incidence of TBI, especially after the age of 4 [ 4 ]. In Finland, the incidence of mild pTBI increased continuously from 1998 through 2018, whereas the incidence of severe TBIs that require acute neurosurgical interventions remained the same [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of childhood traumatic brain injury on fitness for service class, length of service period, and cognitive performance during military service in Finland from 1998 to 2018: A retrospective register-based nationwide cohort study

Möttönen,

Ponkilainen,

Mattila

et al. 2024

PLoS ONE

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Introduction Traumatic brain injury (TBI) can cause neuronal damage and cerebrovascular dysfunction, leading to acute brain dysfunction and considerable physical and mental impairment long after initial injury. Our goal was to assess the impact of pediatric TBI (pTBI) on military service, completed by 65–70% of men in Finland. Methods We conducted a retrospective register-based nationwide cohort study. All patients aged 0 to 17 years at the time of TBI, between 1998 and 2018, were included. Operatively and conservatively treated patients with pTBI were analyzed separately. The reference group was comprised of individuals with upper and lower extremity fractures. Information on length of service time, service completion, fitness for service class, and cognitive performance in a basic cognitive test (b-test) was gathered from the Finnish Military Records for both groups. Linear and logistic regression with 95% CI were used in comparisons. Results Our study group comprised 12 281 patients with pTBI and 20 338 reference group patients who participated in conscription. A total of 8 507 (66.5%) men in the pTBI group and 14 953 (71.2%) men in the reference group completed military service during the follow-up period. Men in the reference group were more likely to complete military service (OR 1.26, CI 1.18–1.34). A total of 31 (23.3%) men with operatively treated pTBI completed the military service. Men with conservatively treated pTBI had a much higher service rate (OR 7.20, CI 4.73–11.1). In the pTBI group, men (OR 1.26, CI 1.18–1.34) and women (OR 2.05, CI 1.27–3.36) were more likely to interrupt military service than the reference group. The PTBI group scored 0.15 points (CI 0.10–0.20) less than the reference group in cognitive b-test. Conclusions PTBI groups had slightly shorter military service periods and higher interruption rate than our reference-group. There were only minor differences between groups in cognitive b-test.

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Increasing incidence of pediatric mild traumatic brain injury in Finland – a nationwide register study from 1998 to 2018

Cited by 7 publications

References 27 publications

Incidence of acute neurosurgery for traumatic brain injury in children—a nationwide analysis from 1998 to 2018

Incidence of acute neurosurgery for traumatic brain injury in children—a nationwide analysis from 1998 to 2018

Association between pediatric traumatic brain injury and epilepsy at later ages in Finland: A nationwide register‐based cohort study

Impact of childhood traumatic brain injury on fitness for service class, length of service period, and cognitive performance during military service in Finland from 1998 to 2018: A retrospective register-based nationwide cohort study

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