title: Traumatic brain injury in the Netherlands, trends in emergency department visits, hospitalization and mortality between 1998 and 2012.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. The effects of epidemiological changes such as ageing of the population and increased traffic safety on the incidence of TBI are unknown.
  
  
  OBJECTIVE
  The objective of this study was to evaluate trends in TBI-related emergency department (ED) visits, hospitalization and mortality in the Netherlands between 1998 and 2012.
  
  
  METHODS
  This was a retrospective observational, longitudinal study.
  
  
  METHODS
  The main outcome measures were TBI-related ED visits, hospitalization and mortality.
  
  
  RESULTS
  Between 1998 and 2012, there were 500 000 TBI-related ED visits in the Netherlands. In the same period, there were 222 000 TBI-related admissions and 17 000 TBI-related deaths. During this period, there was a 75% increase in ED visits for TBI and a 95% increase for TBI-related hospitalization; overall mortality because of TBI did not change significantly. Despite the overall increase in TBI-related ED visits, this increase was not evenly distributed among age groups or trauma mechanisms. In patients younger than 65 years, a declining trend in ED visits for TBI caused by road traffic accidents was observed. Among patients 65 years or older, ED visits for TBI caused by a fall increased markedly. TBI-related mortality shifted from mainly young (67%) and middle-aged individuals (<65 years) to mainly elderly (63%) individuals (≥65 years) between 1998 and 2012. The conclusions of this study did not change when adjusting for changes in age, sex and overall population growth.
  
  
  CONCLUSIONS
  The incidence of TBI-related ED visits and hospitalization increased markedly between 1998 and 2012 in the Netherlands. TBI-related mortality occurred at an older age. These observations are probably the result of a change in aetiology of TBI, specifically a decrease in traffic accidents and an increase in falls in the ageing population. This hypothesis is supported by our data. However, ageing of the population is not the only cause of the changes observed; the observed changes remained significant when correcting for age and sex. The higher incidence of TBI with a relatively stable mortality rate highlights the importance of clinical decision rules to identify patients with a high risk of poor outcome after TBI.
authors.affiliation: Departments of Emergency Medicine.
authors.forename: Crispijn L
authors.initials: CL
authors.lastname: Van den Brand
authors.affiliation: Department of Intensive Care Medicine, Haga Hospital, The Hague.
authors.forename: Lennard B
authors.initials: LB
authors.lastname: Karger
authors.affiliation: Consumer Safety Institute (VeiligheidNL), Amsterdam.
authors.forename: Susanne T M
authors.initials: STM
authors.lastname: Nijman
authors.affiliation: Radiology, Erasmus MC, Rotterdam, The Netherlands.|Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Myriam G M
authors.initials: MGM
authors.lastname: Hunink
authors.affiliation: Departments of Emergency Medicine.
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.affiliation: Neurology, Haaglanden Medical Center.
authors.forename: Korné
authors.initials: K
authors.lastname: Jellema
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult