Traumatic Brain Injury in Portugal: Trends in Hospital Admissions from 2000 to 2010

Abstract

<p><strong>Introduction:</strong> Traumatic brain injury has a considerable socio-economic impact, being a major cause of morbi-mortality, often with permanent disability. We sought to characterize health resource utilization of adult traumatic brain injury patients in Portugal between 2000 and 2010.<br /><strong>Material and Methods:</strong> Retrospective study of medical records of adult patients with ICD9 diagnostic code of traumatic brain injury included in the National Diagnosis Related Groups Database from 2000–2010. Descriptive statistical analysis was performed and trends during the decade were evaluated.<br /><strong>Results:</strong> We analysed 72 865 admissions to 111 hospitals, 64.1% males, mean age 57.9 ± 21.8 years (18-107). We found a decrease in number of traumatic brain injury in younger patients and an increase in older ones. The number of traffic accidents decreased and the number of falls increased. There was an increase of moderate to severe traumatic brain injury admissions: 47.2% in 2000 / 80% in 2010. Patients admitted in Intensive Care have nearly doubled (15.8% vs 29.5%) as well as the number submitted to neurosurgical procedures (8.2% vs 15.2%). Total mortality increased from 7.1% to 10.6%.<br /><strong>Discussion:</strong> The decrease of traumatic brain injury may be associated with the trauma prevention campaigns, road network improvement and health politics. The increase in mortality may be related to better pre-hospital care, enabling more severe cases to arrive in hospital alive, and although treated more frequently in Intensive Care and requiring more neurosurgical procedures, they end up having higher mortality. Also this may be due to an increase in patients’ age and worse pre-morbid status.<br /><strong>Conclusion:</strong> Traumatic brain injury in Portugal is changing. Although hospital admissions due to global traumatic brain injury have decreased, mortality rate has increased.<br /><strong>Keywords:</strong> Intensive Care Units; Brain Injuries; Hospitalization; Portugal.</p>

Changing Epidemiological Patterns in Traumatic Brain Injury: A Longitudinal Hospital-Based Study in Belgium

“…A strong feature of our study is the complete standardization of data collection over the 10-year study period and the access to raw data, permitting age-adjusted analyses. Even though Belgium is only a small country in Europe, we are of the opinion that our results can be generalized to other European countries, and this is supported by other studies [15,16,17,18,19,20]. In terms of population, Belgium is one of the top 10 of the European Union, more precisely in the 9th place [27].…”

“…Table 2 gives an overview of 6 other studies conducted in Europe [15,16,17,18,19,20] reporting on the incidence of hospital admissions for TBI across shorter or longer time periods. These studies often focused on different time periods, thus making direct comparisons complex.…”

“…Studies reporting on time periods before 2000 generally describe relatively stable hospital admission-based incidence rates [15,16,17], while those reporting on periods after 2000 describe a decrease in hospital admissions for TBI [18,19,20]. …”

Sobre a Necessidade de Promover a Prevenção Primária do Traumatismo Craniano

“…Isto deveu-se possivelmente ao aumento da severidade do TCE, mas também os cuidados pré-hospitalares portugueses melhoraram, tal resultando em que casos que anteriormente seriam letais no pré-hospitalar conseguissem chegar vivos ao hospital, ainda que em estado muito grave; embora sujeitos a tratamento, acabaram por contribuir para o aumento da mortalidade intra-hospitalar registada. 2 Os números mais atuais disponíveis de Portugal estão alinhados com a realidade da União Europeia, e evidenciam que a taxa de incidência de lesão encefálica traumática diminuiu para valores na ordem dos 62 -65/100 000 /ano no período 2011 -2014, e que nesse mesmo período, as taxas de mortalidade mostram também um drástico declínio para valores de 9 -10/100 000 /ano. 3 Todavia, o fenómeno do traumatismo craniano medido a nível de internamento hospitalar (TCE major), não é sinónimo necessariamente de que a incidência de traumatismo craniano como fenómeno global esteja a decrescer na comunidade.…”

“…Esta possibilidade pode melhorar a relação médico-doente, que passa a ser baseada na confiança e não apenas na obrigatoriedade. 2 O conhecimento das razões de mudança de médico pode ser útil para melhorar a relação médico-doente, a satisfação dos utentes e a qualidade dos cuidados prestados. Este estudo avaliou as razões evocadas pelos utentes maiores de 18 anos para mudança de médico, em uma unidade de saúde familiar da Região Centro, através da consulta dos formulários de mudança de médico, preenchidos no período compreendido entre 1 de janeiro de 2016 a 30 de junho de 2017.…”