Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

Abstract

Background: The vast majority of hospital admitted patients with traumatic brain injury (TBI) will have intracranial injury identified by neuroimaging, requiring qualified staff and hospital beds. Moreover, increased pressure in health care services is expected because of an aging population. Thus, a regular evaluation of characteristics of hospital admitted patients with TBI is needed. Oslo TBI Registry-Neurosurgery prospectively register all patients with TBI identified by neuroimaging admitted to a trauma center for southeast part of Norway. The purpose of this study is to describe this patient population with respect to case load, time of admission, age, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival. Methods: Data for 5 years was extracted from Oslo TBI Registry-Neurosurgery. Case load, time of admission, age, sex, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival was compiled and compared. Results: From January 1st, 2015 to December 31st, 2019, 2153 consecutive patients with TBI identified by neuroimaging were registered. The admission rate of TBI of all severities has been stable year-round since 2015. Mean age was 52 years (standard deviation 25, range 0-99), and 68% were males. Comorbidities were common; 28% with pre-injury ASA score of ≥3 and 25% used antithrombotic medication. The dominating cause of injury in all ages was falls (55%) but increased with age. Upon admission, the head injury was classified as mild TBI in 46%, moderate in 28%, and severe (Glasgow coma score ≤ 8) in 26%. Case load was stable without seasonal variation. Majority of patients (68%) were admitted during evening, night or weekend. 68% was admitted to intensive care unit. Length of hospital stay was 4 days (median, interquartile range 3-9). 30-day survival for mild, moderate and severe TBI was 98, 94 and 69%, respectively. Conclusions: The typical TBI patients admitted to hospital with abnormal neuroimaging were aged 50-79 years, often with significant comorbidity, and admitted outside ordinary working hours. This suggests the necessity for allhour presence of competent health care professionals.

In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation

“…In a systematic review [13], the only consistent negative predictor for discharge to specialized rehabilitation was increasing age. Preinjury comorbidity and functional impairments were highly associated with age in our study population [19]. We found these factors to have a significant negative impact on the probability of treatment in the direct pathway, similar to the literature on stroke [15,16].…”

“…The inclusion criteria for the Oslo TBI Registry-Neurosurgery were (i) traumatic brain injury; (ii) cerebral CT/CTA or cerebral MRI/MRA with findings of acute trauma (hemorrhage, fracture, traumatic axonal injury, vascular injury); (iii) admission to OUH within seven days postinjury; and (iv) Norwegian social security number. A more thorough description of patients in this registry has been published previously [19]. For this study, we included adult patients (age ≥18 years) who were residents of the southeastern region, admitted to OUH between 1 January 2015 and 31 December 2019, and discharged alive from the acute care units at OUH.…”

Incidence of emergency neurosurgical TBI procedures: A population-based study

“…Given the low rate of emergency neurosurgery, it is evident that only a few centers in each country or region can provide competent neurosurgical services. As patients with TBI are often admitted outside of ordinary working hours, it is important that competent personnel are available 24 hours a day and 7 days a week to provide the best possible treatment for TBI (24). To achieve this, optimal collaboration and organization between hospitals is imperative, irrespective of distance to the trauma center.…”

“…To be included in the Oslo TBI Registry -Neurosurgery, all of the following criteria must be ful lled: (i) traumatic brain injury; (ii) cerebral CT/CTA or cerebral MRI/MRA with ndings of acute trauma (hemorrhage, fracture, traumatic axonal injury, vascular injury); (iii) admission to OUH within seven days of injury; and (iv) a Norwegian social security number. A more thorough description of the database and patient characteristics has been previously described (24). Data were retrieved for patients admitted between January 1, 2015, and December 31, 2019, on September 4, 2020.…”

Impact of Preinjury Antithrombotic Therapy on 30–Day Mortality in Older Patients Hospitalized With Traumatic Brain Injury (TBI)

“…This study uses data from the “Oslo TBI Registry—Neurosurgery,” a prospective quality control database run by the neurosurgical department at OUH ( 21 ). The Registry uses the Medinsight database platform under the approval of the OUH Data Protection Officer (DPO approval number 2016/17569).…”