Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk.
OBJECTIVE
This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI.


METHODS
Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study).


METHODS
Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident.


RESULTS
A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ(2)=78.47; p<0.0001). Patients suffering from an upper limb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ(2)=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ(2)=7.07; p=0.008).


CONCLUSIONS
Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI.
Research Center in Neuropsychology and Cognition (CERNEC), Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada.
Marianne
M
Jodoin
Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada. Electronic address: dominique.rouleau@umontreal.ca.
Dominique M
DM
Rouleau
Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada.
Camille
C
Charlebois-Plante
Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada.
Benoit
B
Benoit
Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada.
Stéphane
S
Leduc
Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada.
G-Yves
GY
Laflamme
Research Center in Neuropsychology and Cognition (CERNEC), Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada.
Nadia
N
Gosselin
Research Center in Neuropsychology and Cognition (CERNEC), Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada.
Camille
C
Larson-Dupuis
Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Quebec at Trois-Rivieres, Trois-Rivieres, Quebec, Canada.
Louis
L
De Beaumont
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000150:complications / Q000453:epidemiology*; D001924:Brain Concussion / Q000175:diagnosis* / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D055815:Young Adult
Incidence rate; Mild traumatic brain injury; Orthopaedic monotrauma