Severe Traumatic Brain Injury in a High-Income Country: An Epidemiological Study

Abstract

This adult cohort determined the incidence and patients' short-term outcomes of severe traumatic brain injury (sTBI) in Switzerland and age-related differences. A prospective cohort study with a follow-up at 14 days was performed. Patients ≥16 years of age sustaining sTBI and admitted to 1 of 11 trauma centers were included. sTBI was defined by an Abbreviated Injury Scale of the head (HAIS) score >3. The centers participated from 6 months to 3 years. The results are presented as percentages, medians, and interquartile ranges (IQRs). Subgroup analyses were performed for patients ≤65 years (younger) and >65 (elderly). sTBI was observed in 921 patients (median age, 55 years; IQR, 33-71); 683 (74.2%) were male. Females were older (median age, 67 years; IQR, 42-80) than males (52; IQR, 31-67; p<0.00001). The estimated incidence was 10.58 per 100,000 inhabitants per year. Blunt trauma was observed in 879 patients (95.4%) and multiple trauma in 283 (30.7%). Median Glasgow Coma Score (GCS) on the scene was 9 (IQR 4-14; 8 in younger, 12 in elderly) and in emergency departments 5 (IQR, 3-14; 3 in younger, 8 in elderly). Trauma mechanisms included the following: 484 patients with falls (52.6%; younger, 242 patients [50.0%]; elderly, 242 [50.0%]), 291 with road traffic accidents (31.6%; younger, 237 patients [81.4%]; elderly, 54 [18.6%]), and 146 with others (15.8%). Mortality was 30.2% (24.5% in younger, 40.9% in elderly). Median GCS at 14 days was 15 (IQR, 14-15) without differences among subgroups. Estimated incidence of sTBI in Switzerland was low, age was high, and mortality considerable. The elderly had higher initial GCS and a higher death rate, but high GCS at 14 days.

Rate of Disorders of Consciousness in a Prospective Population-Based Study of Adults With Traumatic Brain Injury

“…44 Fatality rates might also affect the occurrence of prolonged DOC. In-hospital fatality rate in the sTBI study at large was 29%, 26 of which 88% occurred within the first week, representing fatality rates in accordance with earlier reports 42,43,[45][46][47] and confirming high in-hospital fatality in the most severe injuries. 48 In accordance with this, only one patient with DOC died before the 12-month follow-up, tentatively confirming that patients with DOC who survive the first year postinjury can have a good chance of survival over the following years.…”

“…However, comparing their findings with the Norwegian numbers, the authors found that when sTBI was defined by a GCS score below 8, incidence numbers decreased to 5 per 100 000, in accordance with the Norwegian data. 42 Actually, the recent Swedish study of DOC incidence estimates 1.4 per 100 000 with sTBI in Sweden, suggesting even a lower occurrence than Norway and Switzerland. 18 However, within the 2-year sampling period of this study, the occurrence of DOC varied from 5 in 2009 to 2 in 2010.…”

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

“…This study is a part of the Swiss National Cohort of severe TBI entitled “Patient-relevant Endpoints after Brain Injury from Traumatic Accidents” (PEBITA; http://www.pebita.ch). Demographic data of this study has been published recently [24]. …”

Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review

“…Some early studies used ICD 8 (e.g., Engberg and Teasdale [1998]). 23 Other standardized coding schemes, such as the Abbreviated Injury Score for head injuries (AIS Head or HAIS) as in Walder and colleagues (2013), 24 and the Glasgow Coma Scale (GCS) as in Boto and colleagues (2009), 25 also were used occasionally. In summary, 31 studies used ICD (8th, 9 th , or 10th revision), and 20 studies used GCS or GCS and/or other criteria (usually AIS).…”