Prospective observational cohort study on epidemiology, treatment and outcome of patients with traumatic brain injury (TBI) in German BG hospitals

Abstract

ObjectivesSince 2000/2001, no large-scale prospective studies addressing traumatic brain injury (TBI) epidemiology in Germany have been published. Our aim was to look for a possible shift in TBI epidemiology described in other European countries, to look for possible changes in TBI management and to identify predictors of 1-year outcome especially in patients with mild TBI.DesignObservational cohort study.SettingAll patients suffering from a TBI of any degree between 1 October 2014 and 30 September 2015, and who arrived in one of the seven participating BG hospitals within 24 hours after trauma, were included.ParticipantsIn total, 3514 patients were included.Outcome measuresInitial care, acute hospital care and rehabilitation were documented using standardised documentation forms. A standardised telephone interview was conducted 3 and 12 months after TBI in order to obtain information on outcome.ResultsPeaks were identified in males in the early 20s and mid-50s, and in both sexes in the late 70s, with 25% of all patients aged 75 or older. A fall was the most frequent cause of TBI, followed by traffic accidents (especially bicyclists). The number of head CT scans increased, and the number of conventional X-rays of the skull decreased compared with 2000/2001. Besides, more patients were offered rehabilitation than before. Though most TBI were classified as mild, one-third of the patients participating in the telephone interview after 12 months still reported troubles attributed to TBI. Negative predictors in mild TBI were female gender, intracranial bleeding and Glasgow Coma Scale (GCS) 13/14.ConclusionThe observed epidemiologic shift in TBI (ie, elderly patients, more falls, more bicyclists) calls for targeted preventive measures. The heterogeneity behind the diagnosis ‘mild TBI’ emphasises the need for defining subgroups not only based on GCS.

Epidemiological and clinical characteristics predictive of ICU mortality of patients with traumatic brain injury treated at a trauma referral hospital – a cohort study

“…Falls from the same level and traffic accidents were the main trauma mechanisms identified, similar to those reported in European studies [18,28]. Falls from the same level are more common in the elderly population, while traffic accidents are more common in the young population [17,18,29].…”

“…Description of the characteristics of individuals with TBI and their association with ICU outcome observations in Europe, where bicycle accidents were more frequent[28][29][30].…”

Classification and Characterization of Traumatic Brain Injuries in the Northern Region of Sweden

“…However, there are differences, such as the fact that their highest TBI incidence was found among those aged over 75 years and for us the peak was among younger children. The late peak among women over the age of 80 years is also seen in other European countries [ 4 , 28 ].…”

The burden of geriatric traumatic brain injury on trauma systems: Analysis of 348,800 Medicare inpatient claims

“…35 Results of our study mirror worldwide trends in developed countries where visits to the ED, inpatient hospitalizations, and mortalities from TBI are increasing in older adults, but are stable or decreasing in other age groups, even accounting for population shifts. These trends are demonstrated in numerous international studies from Australia, 36 Austria, 37 Canada, [38][39][40] China, 41,42 Finland, [43][44][45] Germany, 46 Great Britain, 47 Japan, 48 the Netherlands, 49 Scotland, 50 Spain, 43,51 and the United States. 52 Trends in less developed countries are harder to assess.…”