title: 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: BACKGROUND
  Little is known about the ratio of mild traumatic brain injury (TBI) to moderate and severe TBI, about the time that elapses until primary care is given, about the number of patients requiring immediate surgery and about the early outcome and the costs.
  
  
  METHODS
  In a prospective study two regions taken as model examples were investigated: the City of Hanover with its surrounding catchment area and Münster with its regions.
  
  
  RESULTS
  From 1 March 2000 until 28 February 2001 all patients were recruited who were admitted to a hospital emergency department due to a TBI; 6783 patients (58.4% male, 41.6% female; 29.7% children < 16 years) were included; 5220 (73%) received in-hospital treatment; and 258 were given early rehabilitation. The incidence of TBI is 332 per 100 000 head of population. The GCS (Glasgow Coma Scale) or other forms of neurological examinations were performed in only 56% of all cases. According to the GCS status, 90.2% are classified as mild, 3.9% as moderate and 5.2% as severe. Intubation is given only to 76.1% of patients with severe TBI. Lethality was 1%. The predominant cause of TBI is falls, with 52.5% of all cases, while 26.3% were due to road accidents. The time elapsing between the accident event and initial examination at the hospital is less than 1 hour in 63% of all cases. X-rays were taken in 82% of all cases of TBI, with 19.3% of the patients receiving a CT scan; 58.7% of all TBI patients have additional injuries of the facial skull, 8.8% of the vertebral column, 7.2% of the thorax, 2.6% of the abdomen, 3.4% of the pelvis and 19.6% of one or more extremities. One year after the accident, 50% of all patients still required treatment even after mild TBI.
  
  
  CONCLUSIONS
  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.
authors.affiliation: AKH Celle, Neurosurgery, Celle, Germany. emrickels@t-online.de
authors.forename: Eckhard
authors.initials: E
authors.lastname: Rickels
authors.forename: Klaus
authors.initials: K
authors.lastname: von Wild
authors.forename: Paul
authors.initials: P
authors.lastname: Wenzlaff
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001930:Brain Injuries / Q000453:epidemiology* / Q000209:etiology / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000592:standards*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult