TBI surveillance using the common data elements for traumatic brain injury: a population study

Abstract

BackgroundTo characterize the patterns of presentation of adults with head injury to the Emergency Department.MethodsThis is a cohort study that sought to collect injury and outcome variables with the goal of characterizing the very early natural history of traumatic brain injury in adults. This IRB-approved project was conducted in collaboration with our Institution’s Center for Translational Science Institute. Data were entered in REDCap, a secure database. Statistical analyses were performed using JMP 10.0 pro for Windows.ResultsThe cohort consisted of 2,394 adults, with 40% being women and 79% Caucasian. The most common mechanism was fall (47%) followed by motor vehicle collision (MVC) (36%). Patients sustaining an MVC were significantly younger than those whose head injury was secondary to a fall (P < 0.0001). Ninety-one percent had CT imaging; hemorrhage was significantly more likely with worse severity as measured by the Glasgow Coma Score (chi-square, P < 0.0001). Forty-four percent were admitted to the hospital, with half requiring ICU admission. In-hospital death was observed in 5.4%, while neurosurgical intervention was required in 8%. For all outcomes, worse TBI severity per GCS was significantly associated with worse outcomes (logistic regression, P < 0.0001, adjusted for age).ConclusionThese cohort data highlight the burden of TBI in the Emergency Department and provide important demographic trends for further research.

Classification of traumatic brain injury severity using retrospective data

“…The GCS scores are based on level of consciousness, regardless of CT scan findings. [2] 2.5 Abbreviated Injury Scale score of the head The American Medical Association Committee on Medical Aspects of Automotive Safety initially developed the Abbreviated Injury Scale (AIS) for researchers to have a consistent method of comparing tissue damage injuries acquired in automobile crashes as well as having standardized language and classification of injuries. [14] The AIS assigns a severity score to an injury on a scale from 1 (minor) to 6 (major), where a score of 1 generally does not require inpatient hospital treatment and a score of 6 is almost certainly fatal.…”

“…[13] Generally, studies of the brain have classified patients based on the severity of the brain injury, and not by the associated extracranial injuries. [2] Mild traumatic brain injuries have routinely been defined as a GCS score of 13 to 15 in the TBI literature. Moderate injures relate to a GCS score of 9 to 12; and a GCS score of 3 to 8 is associated with severe brain injuries.…”

“…The classification of the brain injury is important because it often refers to the level of functioning immediately after a TBI and is discussed with regards to the severity of the brain injury; with patients typically divided into the broad categories of mild, moderate, and severe injury. [2] Not only is treatment often based on these categories but also rehabilitation.…”

“…[3] The two most commonly used methods of designating the brain trauma severity after an injury are the Glasgow Coma Scale (GCS) and the head Abbreviated Injury Score (AIS) classification tools. [2] The GCS is a physiologic scale based on clinical examination and the AIS head score is an anatomic score based on computerized tomography (CT) scan, operative or autopsy findings. [4] Although GCS is the most widely used method to classify brain injury in the clinical setting, a major difficulty in retrospective research is that the GCS variable is often missing in a large percentage of patients in large database cohorts.…”

Traumatic brain injury (TBI): morbidity, mortality and economic implications

“…According to the Centers for Disease Control and Prevention (CDC), linked to Department of Health and Human Services, USA, population data on TBI are fundamental for understanding its impact on the population of this country. Knowing the profile of these patients as well as the trauma mechanisms can help formulate prevention strategies, define the research priorities and support services for patients living with traumatic brain injury [3].…”