The broad definition of mild traumatic brain injury (TBI) led the authors of an observational cohort study to the conclusion that, according to the study results published in BMJ Open, different subgroups of TBI must be defined.
The researchers obtained data for this study from 7 hospitals in Germany. They examined patients (N = 3514) who suffered from TBI between 2014 and 2015 for causes, symptoms, care and clinical results over 12 months.
The patients had a mean age of 54.5 (standard deviation [SD], 22.6) years and 59.2% were men. The diagnoses of the International Statistical Classification of Diseases, 10th revision, were S06.0 (37.4%), S00.9 (18.6%), S02.9 (11.2%), S06.6 (7, 5%), S06.5 (5.6%). , S06.7 (3.3%), S06.9 (3.3%), S06.2 (1.7%), S06.3 (1.6%), S06.8 (1.2%) , S06.4 (0.9%), S06 0.1 (0.4%), absent (6.6%) or other (0.9%).
The pre-clinical Glasgow Coma Scale (GCS) initial severity was classified as mild (85.1%), severe (7.7%), and moderate (7.2%). In the emergency room, GCS severity was classified as mild (87.3%), moderate (3.3%), and severe (2.3%).
SHT were most commonly caused by falls, traffic accidents, and external violence. There was a significant association between age (P = 0.019) and cause of TBI (P <0.001), with patients over 50 years of age having the most frequent falls (71.3%) and patients aged 50 years or younger having external TBI Violence (30.6%), traffic accidents (29.0%) and falls (27.3%). Alcohol was involved in 14.4% of TBI.
One third of the patients (35.5%) were admitted to the intensive care unit and 47.6% of these patients required surgery.
Rehabilitation care included physiotherapy (46.5%), speech therapy (5.9%), occupational therapy (4.7%) and neuropsychological therapy (3.1%).
At discharge, 22.3% reported having subjective symptoms such as headache (18.6%) and dizziness (10.2%). 13.1% had neurological deficits.
Most of the patients were discharged home (69.6%), 12.4% in a rehabilitation facility, 7.5% in another acute hospital and 4.1% in a nursing home. Mortality from TBI, cerebral complications, cardiac complications, pulmonary complications, or infections occurred in 4.3%.
In a telephone interview at the age of 12 months, 35.3% said that they still had difficulties because of their TBI and 7.6% had changed their job because of their TBI.
The risk of persistent TBI symptoms was increased in patients with intracranial bleeding (odds ratio [OR], 2.76) and GCS 13 or 14 (OR, 1.82). The risk was reduced in men (OR, 0.62) or patients who were intoxicated with alcohol (OR, 0.45).
This study was limited by its broad, simplified definition of TBI, which included patients with a head injury with no evidence of brain dysfunction.
These data indicated that there were several types of mild TBI, which likely suggests that different subsets of TBI need to be defined in order to more easily identify individuals at risk for long-term effects.
Schwenkreis P, Gonschorek A, Berg F, et al. Prospective observational cohort study on epidemiology, treatment and outcome of patients with traumatic brain injury (TBI) in German professional associations. BMJ open. 2021; 11 (6): e045771. doi: 10.1136 / bmjopen-2020-045771