Citation

Leijdesdorff HA, van Dijck JT, Krijnen P, Vleggeert CL, Schipper IB. J. Neurotrauma 2014; 31(5): 459-465.

Affiliation

Leiden University Medical Center, Department of Trauma Surgery, Leiden, Netherlands ; a.leijdesdorff@gelre.nl.

Copyright

(Copyright © 2014, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2013.3111

PMID

24093437

Abstract

This epidemiological study analyzed the incidence, risk factors, hospital triage and outcome of patients with severe traumatic brain injuries (sTBI) caused by road traffic accidents (RTA) admitted to hospitals in the Trauma Center West-Netherlands (TCWN) region. Trauma registry data were used to identify TBI in all RTA victims admitted to hospitals in the mid-West region of the Netherlands from 2003 to 2011. Type of head injury and severity were classified using the Abbreviated Injury Scale (AIS). Head injuries with AIS severity scores ≥ 3 were considered sTBI. Ten percent of all 12,503 hospital admitted RTA victims sustained sTBI, ranging from 5.4% in motorcyclists, 7.4% in motorists, 9.6% in cyclists and 12.7% in moped riders to 15.1% in pedestrians (p<0.0001). Amongst RTA victims admitted to hospital, sTBI was most prevalent in pedestrians (OR 2.25; 95% CI 1.78-2.86) and moped riders (OR 1.86; 95% CI 1.51-2.30). Injury patterns differed between road user groups. The incidence of contusion ranged from 46.6% in cyclists to 74.2% in motorcyclists, whereas basilar and open skull fractures were least common in motorcyclists (22.6%) and most common in moped riders (51.5%). Haemorrhage incidence ranged from 44.9% (motorists) to 63.6% (pedestrians). Subdural and subarachnoid bleedings were most frequent. Age, Glasgow Coma Scale, and type of haemorrhage were independent prognostic factors for in-hospital mortality after sTBI. In-hospital mortality ranged from 4.2% in moped riders to 14.1% in motorists. Pedestrians have the highest risk to sustain sTBI and more specifically intracranial haemorrhage. Haemorrhage and contusion both occur in over 50% of the patients with sTBI. Specific brain injury patterns can be distinguished for specific road user groups and independent prognostic risk factors for sTBI were identified. This knowledge may be used to improve the vigilance for particular injuries in specific patient groups and stimulate development of focussed diagnostic strategies.

Language: en