Head injury in Germany: A population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas

Rickels, E.; Wild, K. von; Wenzlaff, Paul

doi:10.3109/02699052.2010.498006

Cited by 130 publications

(109 citation statements)

References 22 publications

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“…1 Although the severity of an injury is known to affect outcome after a TBI, it has limited prognostic value. [2][3][4] With mild TBIs (mTBIs), people typically experience a range of short-term postconcussive symptoms (PCSs) that usually resolve in the first few months after an injury; however, a substantial minority report experiencing long-term problems. [5][6][7] Moderate-to-severe injuries, on the other hand, are generally associated with poorer outcomes, [8][9][10][11][12] although outcomes can vary appreciably between injuries that are ostensibly similar in severity.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Psychological Trauma to Outcomes after Traumatic Brain Injury: Assaults versus Sporting Injuries

Mathias

Harman-Smith

Bowden

et al. 2014

Journal of Neurotrauma

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Clinical research into outcomes after traumatic brain injury (TBI) frequently combines injuries that have been sustained through different causes (e.g., car accidents, assaults, and falls), the effect of which is not well understood. This study examined the contribution of injury-related psychological trauma—which is more commonly associated with specific types of injuries—to outcomes after nonpenetrating TBI in order to determine whether it may be having a differential effect in samples containing mixed injuries. Data from three groups that were prospectively recruited for two larger studies were compared: one that sustained a TBI as a result of physical assaults (i.e., psychologically traumatizing) and another as a result of sporting injuries (i.e., nonpsychologically traumatizing), as well as an orthopedic control group (OC). Psychosocial and emotional (postconcussion symptoms, injury-related stress, and depression), cognitive (memory, abstract reasoning, problem solving, and verbal fluency), and functional (general outcome; resumption of home, social, and work roles) outcomes were all assessed. The TBI(assault) group reported significantly poorer psychosocial and emotional outcomes and higher rates of litigation (criminal rather than civil) than both the TBI(sport) and OC groups approximately 6 months postinjury, but there were no differences in the cognitive or functional outcomes of the three groups. The findings suggest that the cause of a TBI may assist in explaining some of the differences in outcomes of people who have seemingly comparable injuries. Involvement in litigation and the cause of an injury may also be confounded, which may lead to the erroneous conclusion that litigants have poorer outcomes.

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Section: Introductionmentioning

confidence: 99%

Contribution of Psychological Trauma to Outcomes after Traumatic Brain Injury: Assaults versus Sporting Injuries

Mathias

Harman-Smith

Bowden

et al. 2014

Journal of Neurotrauma

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“…Consequently, significant differences after rehabilitation of pre-school children compared to school-aged children referring to increased social and behavioural impairment have been analysed [20,40]. In contrast to this assumption, the association of injury severity and outcome deficits diminishes with increasing time since injury [28,36,41], suggesting other influencing factors like social and family environment [37,42].…”

Section: Paediatric Tbimentioning

confidence: 98%

Current Opinions on Epidemiology, Treatment and Outcome After Traumatic Brain Injury

Florian¹

2012

J Trauma Treat

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Traumatic Brain InjuryTraumatic Brain Injury (TBI) continues to be the major cause of disability and death throughout the world despite improvements of research and medical treatment [1]. Consequently, an overview on the current incidence of TBI as well as current treatment options and outcome seems considerably relevant.With 332 Traumatic Brain Injuries per 100,000 inhabitants in Germany every year [2], TBI is still the leading cause of mortality and morbidity worldwide [3] resulting in prolonged rehabilitation and long-term care [4]. In multiple traumatized patients, head injuries are evaluated as the most frequent injury, followed by lower and upper extremity trauma [5]. Examining current data, two major gender-and age-related incidences of TBI can be found: one occurs in the late teens to twenties [6] commonly due to motor vehicle accidents [4] with males being three times as often affected compared to females [7]. The second major incidence occurs in the geriatric population caused by falls due to geriatric co-morbidities [6]. While mortality decreased during the last decades based on medical improvements, the World Health Organization (WHO) predicts that TBI will be the third greatest cause of disease and injury by 2020 [8].Typical symptoms of TBI represent headache, nausea and vomiting, dizziness, blurred vision, paresis, aphasia, seizures and impaired coordination on the physical side [9]. Cognitive impairments include attention, memory and concentration disorders or decreased processing speed whereas behavioural symptoms present as depression, anxiety, agitation or aggression [9]. While these symptoms are present in different injury severities to some extent, most are described to resolve quickly especially after mild TBI [9]. Nevertheless, symptoms can still persist for months or even years regardless of the injury severity of TBI [10,11]. AbstractObjective: The objective of this article is to provide an overview on current incidences of traumatic brain injury (TBI) with special focus on current surgical and non-surgical treatment options as well as outcome.Method: A Medline database search was performed using various combinations of the search terms "traumatic brain injury", "TBI", "treatment", "outcome" "pediatric", "intracranial hypertension", "epidemiology" and "incidence". Results:We found an incidence of TBI of 332/100,000 inhabitants in Germany per year and 219-345/100,000 TBI occurring in children. TBI is still the leading cause of mortality and morbidity worldwide. The overall mortality after TBI is described with 1%.Typical symptoms of TBI represent headache, nausea and vomiting, dizziness, blurred vision, paresis, aphasia, seizures and impaired coordination on the physical side. Cognitive impairments include attention, memory and concentration disorders or decreased processing speed whereas behavioural symptoms present as depression, anxiety, agitation or aggression. Persistence of these symptoms results in a vicious cycle of impaired skill acquisition and an adaptive deficit with increased ...

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“…Leur incidence annuelle est estimée à 1850/100 000 avant 4 ans, 1100/100 000 entre 5 et 9 ans, et 1170/100 000 entre 10 et 14 ans [7], avec une prédominance de garçons similaire à tout âge [6,8]. Environ 80 à 90 % des TC sont légers (GCS [13][14][15] [7], 3 à 10 % d'entre eux sont graves [9,10]. L'incidence des TC graves définis par le seul GCS <9, varie de 2,3 à 17/100 000 et peut atteindre 46/100 000 selon d'autres classifications [9].…”

Section: éPidémiologieunclassified

“…Plus l'enfant est jeune, plus la part des chutes dans les causes de TC augmente [6,13,14] (50 % avant 14 ans, 80 % avant cinq ans). À l'adolescence, les accidents de la voie publique (AVP), de sports et de loisirs deviennent plus fréquents [13][14][15][16]. Les formes graves des nourrissons sont majoritairement le fait de TC infligés par maltraitance.…”

Section: Mécanismes Lésionnelsunclassified

Traumatisme crânien chez l’enfant

Patteau

Chéron

2014

Réanimation

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Les traumatismes crâniens (TC) de l'enfant sont fréquents et bénins dans leur grande majorité. Les formes graves, définies par un score de Glasgow (GCS) < 9, restent la 1 ère cause de décès accidentel dès l'âge d'un an. Leur gravité réside dans la survenue de lésions intracrâniennes (LIC) mises en évidence par la tomodensitométrie cérébrale. Les TC graves relèvent de mesures thérapeutiques protocolisées dans un centre pédiatrique spécialisé. L'objectif est de prévenir les lésions cérébrales secondaires. La réanimation précoce débute sur les lieux de l'accident par le maintien des fonctions vitales. La prise en charge optimale de la multitude d'enfants consultant pour un TC mineur (GCS : 13-15) reste à définir. Elle repose sur l'évaluation de la gravité potentielle du TC qui seule détermine l'indication d'une tomodensitométrie. L'urgentiste doit mettre en balance le risque de manquer une LIC neurochirurgicale avec celui de malignité future liée aux radiations ionisantes. La valeur prédictive de LIC d'une fracture du crâne, d'un céphalhématome, d'une perte de connaissance initiale, d'une amnésie, d'une convulsion immédiate, de vomissements, de céphalées, d'une cinétique élevée et d'un âge < 2 ans est controversée. Les règles de décision clinique publiées permettent d'identifier les rares LIC avec une excellente sensibilité mais au prix d'un nombre élevé de tomodensitométries cérébrales normales. Le recours à une brève période d'observation des enfants dont la bénignité du TC ne peut être affirmée dès l'évalua-tion clinique initiale est une alternative de choix. Mots clés Traumatisme crânien · Scanner cérébral · Fracture du crâne · Maltraitance · EnfantAbstract Head trauma in children is common and overwhelmingly benign. Severe forms, defined by a Glasgow Coma Scale (GCS) < 9, are the leading cause of death in children aged more than one year. Severity is related to the intracranial injuries identified by computed tomography (CT)-scan. Management of severe traumatic brain injuries (TBI) based on standardized critical care strategy in paediatric trauma centers aims to prevent secondary brain injuries. Early resuscitation starts on the scene and first need to stabilize main functions. Optimal management of the multitude of children with mild blunt head trauma (GCS: 13-15) remains to define. It relies on prognosis evaluation that determines the need for CT-scan. Emergency physicians must balance the possibility of missing a clinically significant TBI, especially those needing acute neurosurgery and the risks of future malignancies associated with ionizing radiation. The predictive values for TBI of skull fracture, scalp hematoma, loss of consciousness, amnesia, seizure, vomiting, rapid kinetics as well as age less than 2 years are controversial. Clinical decision rules identify TBI with an excellent sensitivity but with a high rate of obtaining normal CT-scans. The short observation of children for whom the benignity of head trauma cannot be definitively assessed based on the initial clinical evaluation seems to be ben...

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Head injury in Germany: A population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas

Abstract: It is necessary to follow the TBI guidelines, e.g. regarding intubation and neurological examination. The indication for cranial x-rays and CT should be reconsidered.

Cited by 130 publications

References 22 publications

Contribution of Psychological Trauma to Outcomes after Traumatic Brain Injury: Assaults versus Sporting Injuries

Contribution of Psychological Trauma to Outcomes after Traumatic Brain Injury: Assaults versus Sporting Injuries

Current Opinions on Epidemiology, Treatment and Outcome After Traumatic Brain Injury

Traumatisme crânien chez l’enfant

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