title: Demographic profile and extent of healthcare resource utilisation of patients with severe traumatic brain injury: still a major public health problem.
abstract: BACKGROUND
  Trauma is the fifth principal cause of death in Singapore, with traumatic brain injury (TBI) being the leading specific subordinate cause.
  
  
  METHODS
  This study was an eight-year retrospective review of the demographic profiles of patients with severe TBI who were admitted to the neurointensive care unit (NICU) of the National Neuroscience Institute at Tan Tock Seng Hospital, Singapore, between 2004 and 2011.
  
  
  RESULTS
  A total of 780 TBI patients were admitted during the study period; 365 (46.8%) patients sustained severe TBI (i.e. Glasgow Coma Scale score ≤ 8), with the majority (75.3%) being male. The ages of patients with severe TBI ranged from 14-93 years, with a bimodal preponderance in young adults (i.e. 21-40 years) and elderly persons (i.e. > 60 years). Motor vehicle accidents (48.8%) and falls (42.5%) were the main mechanisms of injury. Invasive line monitoring was frequently employed; invasive arterial blood pressure monitoring and central venous pressure monitoring were used in 81.6% and 60.0% of the patients, respectively, while intracranial pressure (ICP) measurement was required in 47.4% of the patients. The use of tiered therapy to control ICP (e.g. sedation, osmotherapy, cerebrospinal fluid drainage, moderate hyperventilation and barbiturate-induced coma) converged with international practices.
  
  
  CONCLUSIONS
  The high-risk groups for severe TBI were young adults and elderly persons involved in motor vehicle accidents and falls, respectively. In the NICU, the care of patients with severe TBI requires heavy utilisation of resources. The healthcare burden of these patients extends beyond the acute critical care phase.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Jing Zhong
authors.initials: JZ
authors.lastname: Wee
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Yun Rui Jasmine
authors.initials: YR
authors.lastname: Yang
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Qian Yi Ruth
authors.initials: QY
authors.lastname: Lee
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Kelly
authors.initials: K
authors.lastname: Cao
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Chin Ted
authors.initials: CT
authors.lastname: Chong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011634:Public Health; D040841:Resource Allocation; D012189:Retrospective Studies; D012846:Singapore; D055815:Young Adult
keywords: demographics; healthcare utilisation; traumatic brain injury