High-Risk Periods for Adult Traumatic Brain Injuries: A Nationwide Population-Based Study

Abstract

<b><i>Introduction:</i></b> There is minimal existing available information on nationwide seasonal peaks in traumatic brain injuries (TBIs). This lack of information is an impediment to the effective development of prevention programs, societal policies, and hinders the resourcing of medical emergency services. Our current aim is to study nationwide population-based high-risk periods TBI over a 15-year study period in Finland. <b><i>Methods:</i></b> Nationwide databases were searched for all admissions with a TBI diagnosis and later for deaths of persons ≥16 years of age during 2004–2018. The search included all hospitals that provide acute TBI care in Finland. <b><i>Results:</i></b> The study period included 69,231 TBI-related hospital admissions (men = 62%). We found that for men, the highest rate of TBIs occurred on Saturdays, whereas women experience the highest rate of TBIs on Mondays. The highest rate of TBIs in men occurred in July, while women experienced the highest rate of TBIs in January. TBI-related hospital admissions (incidence risk ratio [IRR] 1.090, 95% CI 1.07–1.11, <i>p</i> < 0.0001) and mortality within 30 days after TBI (hazard ratio [HR] 1.057, 95% CI 1.001–1.116, <i>p</i> = 0.0455) were more common on public holidays and weekends than on weekdays. There was an increasing trend in the proportion of TBI-related hospital admissions occurring on public holidays and weekends from 2004 (31.5%) to 2018 (33.4%) (<i>p</i> = 0.0007). In summer months, TBI-related hospital admissions (IRR 1.10, 95% CI 1.08–1.12, <i>p</i> < 0.0001) and 30-day mortality (HR 1.069, 95% CI 1.010–1.131, <i>p</i> = 0.0211) were more common than in other months. TBIs occurred more often in younger and healthier individuals on these index days and times. In terms of specific public holidays, the TBI risk was overall higher on New Year’s Eves and Days (IRR 1.40, 95% CI 1.25–1.58, <i>p</i> < 0.0001) and Midsummer’s Eves and Days (IRR 1.36, 95% CI 1.20–1.54, <i>p</i> < 0.0001), compared to nonworking days. This finding was significant in both genders. <b><i>Conclusions:</i></b> TBI-related hospital admissions and mortality were more common on public holidays, weekends, and in summer months in Finland. People who sustained TBIs on these days were on average younger and healthier. The occurrence of TBIs on public holidays and weekends is increasing at an alarming rate.

Changing epidemiology of traumatic brain injury among the working‐aged in Finland: Admissions and neurosurgical operations

“…However, it is known that in Finland, as in many other countries, the incidence rate of TBIs among older people is currently increasing 10,20–22 . On the contrary, we have recently reported that at the same time, TBIs in leisure time are becoming more common among young and healthy individuals 23 …”

“…10,[20][21][22] On the contrary, we have recently reported that at the same time, TBIs in leisure time are becoming more common among young and healthy individuals. 23 Significant variation in the incidence rates of TBI-related admissions in Europe has been reported depending on the country, region, study period, and age group. Reported incidence rates in regional populations or hospital catchment areas have previously been reported to be somewhat higher than in nationwide studies.…”

Is there a weekend effect on mortality rate and outcome for moderate and severe traumatic brain injury? A population-based, observational cohort study

“…Moderate and severe TBI as well as general trauma admissions peak during the weekends ( Bjarkø et al., 2019 ; Cantwell et al., 2015 ). Contrary to the observed trend in TBI with most patients being older and having associated comorbidities, weekend admissions are predominated by younger, healthier patients often admitted with coexisting alcohol intoxication ( Bjarkø et al., 2019 ; Posti et al., 2021 ). The hypothesis that weekend admissions are associated with increased mortality rate is termed “weekend effect” and it has been demonstrated in various medical conditions for instance myocardial infarction and stroke ( Kostis et al., 2007 ; Mekonnen et al., 2020 ).…”

“…However, differential mortality was not seen in a study of a Level 1 trauma center comparing the days of the week, possibly due to trauma teams being adequately staffed throughout the week ( Carr et al., 2010 ). There are few studies on TBI-related mortality during the weekend, but a recent Finnish study recognized increased mortality rate ( Posti et al., 2021 ) while another study solely focusing on older patients (>65 years) with moderate and severe TBI reported increased mortality rate during the weekends ( Schneider et al., 2012 ).…”

GPT-agents based on medical guidelines can improve the responsiveness and explainability of outcomes for traumatic brain injury rehabilitation

“…Based on date provided by the World Health Organization, traumatic brain injury (TBI) is the third leading cause of death globally 1 , accounting for nearly half of all injury-related deaths worldwide 1 , 2 . Moreover, TBI is a major cause of acquired disability worldwide; however, effective treatment methods are scarce 3 .…”