Adult sports-related traumatic brain injury in United States trauma centers

Abstract

Neurosurg Focus 40 (4):E4, 2016T raumaTic brain injury (TBI) is an alteration in brain function or other evidence of brain abnormality, resulting from an external force applied to the head. Traumatic brain injury occurs in several settings common to daily life, including recreational activities. 21,25,30 In the United States, more than 2.5 million people seek medical care for TBI annually.13 Underreporting of sports-related injuries, lack of consensus definitions, or limited recognition of milder injuries likely leads to gross underestimation of the true incidence of TBI.36 Approximately 70%-90% of all TBIs are comparatively mild and frequently given the colloquial term "concussion. obJeCtive Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. MethoDs Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at a < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. resUlts From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CoNClUsioNs Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use-...

Assessing the risk for major injuries in equestrian sports

“…A recent study found equine-related accidents to be the most important contributor to sports-related traumatic brain injuries in the USA (45.2%). 24 The protective effect of riding helmet was shown multiple times before. 9 11 12 25–27 Bilaniuk et al found a significant lower ISS and incidence of intracranial injury in patients wearing a helmet.…”

Pediatric sports-related traumatic brain injury in United States trauma centers

“…A previous review determined that the sample size of 100 hospitals can be extrapolated to represent the national patient distribution. 56 Detailed data qualification, selection, cleaning, and standardization algorithms have been previously reported. 45 Because the NSP of the NTDB is a fully deidentified data set without the 18 federal Health Insurance Portability and Accountability Act identifiers, the current study was classified as being exempt from institutional review board review.…”

Neurosurgical Emergencies in Sports Neurology

“…Recently, a group from UCSF has utilized data from the National Sample Program of the National Trauma Data Bank to describe the incidence of pediatric and adult sports-related traumatic brain injury in US Trauma Centers [ 5 •, 6 •]. They estimated that 18,310 adult and 11,614 pediatric TBIs present to level I or level II trauma centers in the USA each year.…”

“…In children, the mortality was 0.8 % of sports-related TBI. The authors found that the severity of head and extracranial injuries predicted prolonged hospital and ICU stays, medical complications, failure to discharge home, and death, with age and hypotension being additional predictors for the adult population but not for children [ 5 •, 6 •].…”