title: Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study.
abstract: Changes in the demographics, approach, and treatment of traumatic brain injury (TBI) patients require regular evaluation of epidemiological profiles, injury severity classification, and outcomes. This prospective multicenter study provides detailed information on TBI-related variables of 508 moderate-to-severe TBI patients. Variability in epidemiology and outcome is examined by comparing our cohort with previous multicenter studies. Additionally, the relation between outcome and injury severity classification assessed at different time points is studied. Based on the emergency department Glasgow Coma Scale (GCS), 339 patients were classified as having severe and 129 as having moderate TBI. In 15%, the diagnosis differed when the accident scene GCS was used for classification. In-hospital mortality was higher if severe TBI was diagnosed at both time points (44%) compared to moderate TBI at one or both time points (7-15%, p<0.001). Furthermore, 14% changed diagnosis when a threshold (≥6 h) for impaired consciousness was used as a criterion for severe TBI: In-hospital mortality was<5% when impaired consciousness lasted for<6 h. This suggests that combining multiple clinical assessments and using a threshold for impaired consciousness may improve the classification of injury severity and prediction of outcome. Compared to earlier multicenter studies, our cohort demonstrates a different case mix that includes a higher age (mean=47.3 years), more diffuse (Traumatic Coma Databank [TCDB] I-II) injuries (58%), and more major extracranial injuries (40%), with relatively high 6 month mortality rates for both severe (46%) and moderate (21%) TBI. Our results confirm that TBI epidemiology and injury patterns have changed in recent years whereas case fatality rates remain high.
authors.affiliation: Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Teuntje M J C
authors.initials: TM
authors.lastname: Andriessen
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Gaby
authors.initials: G
authors.lastname: Franschman
authors.forename: Joukje
authors.initials: J
authors.lastname: van der Naalt
authors.forename: Iain
authors.initials: I
authors.lastname: Haitsma
authors.forename: Bram
authors.initials: B
authors.lastname: Jacobs
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Vos
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000145:classification / Q000453:epidemiology* / Q000628:therapy*; D002985:Clinical Protocols; D003627:Data Interpretation, Statistical; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D019983:Guideline Adherence; D006801:Humans; D007258:Informed Consent; D015601:Injury Severity Score; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult