Citation

Andriessen T, Horn J, Franschman G, van der Naalt J, Haitsma I, Jacobs B, Steyerberg EW, Vos PE. J. Neurotrauma 2011; 28(10): 2019-2031.

Affiliation

Radboud University Nijmegen Medical Center, Neurology, P.O. Box 9101, Nijmegen, Netherlands, 6500 HB; TMJC.Andriessen@neuro.umcn.nl.

Copyright

(Copyright © 2011, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2011.2034

PMID

21787177

Abstract

Changes in the demographics, approach and treatment of Traumatic Brain Injury (TBI) patients require regular evaluation of epidemiologic profiles, injury severity classification and outcomes. This prospective multicenter study provides detailed information on TBI related variables of 508 moderate-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 severe and 129 as 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<.001). Furthermore, 14% changed diagnosis when a threshold (≥6 hours) for impaired consciousness was used as criterion for severe TBI: In-hospital mortality was <5% when impaired consciousness was <6 hours. 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 (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 while case fatality rates remain high.

Language: en