Moderate and severe traumatic brain injury in general hospitals: a ten-year population-based retrospective cohort study in central Norway.

BACKGROUND: Patients with moderate and severe traumatic brain injury (TBI) are admitted to general hospitals (GHs) without neurosurgical services, but few studies have addressed the management of these patients. This study aimed to describe these patients, the rate of and reasons for managing patients entirely at the GH, and differences between patients managed entirely at the GH (GH group) and patients transferred to the regional trauma centre (RTC group). We specifically examined the characteristics of elderly patients. METHODS: Patients with moderate (Glasgow Coma Scale score 9-13) and severe (score ≤ 8) TBIs who were admitted to one of the seven GHs without neurosurgical services in central Norway between 01.10.2004 and 01.10.2014 were retrospectively identified. Demographic, injury-related and outcome data were collected from medical records. Head CT scans were reviewed. RESULTS: Among 274 patients admitted to GHs, 137 (50%) were in the GH group. The transferral rate was 58% for severe TBI and 40% for moderate TBI. Compared to the RTC group, patients in the GH group were older (median age: 78 years vs. 54 years, p < 0.001), more often had a preinjury disability (50% vs. 39%, p = 0.037), and more often had moderate TBI (52% vs. 35%, p = 0.005). The six-month case fatality rate was low (8%) in the GH group when transferral was considered unnecessary due to a low risk of further deterioration and high (90%, median age: 87 years) when neurosurgical intervention was considered nonbeneficial. Only 16% of patients ≥ 80 years old were transferred to the RTC. For this age group, the in-hospital case fatality rate was 67% in the GH group and 36% in the RTC group and 84% and 73%, respectively, at 6 months. CONCLUSIONS: Half of the patients were managed entirely at a GH, and these were mainly patients considered to have a low risk of further deterioration, patients with moderate TBI, and elderly patients. Less than two of ten patients ≥ 80 years old were transferred, and survival was poor regardless of the transferral status.

Risk factors for aneurysmal subarachnoid hemorrhage in a prospective population study: the HUNT study in Norway.

BACKGROUND AND PURPOSE: The morbidity and mortality of subarachnoid hemorrhage (SAH) are high, and established risk factors are scarce. We prospectively assessed the association of blood pressure, smoking, and body mass with the risk of aneurysmal SAH. METHODS: All residents >or=20 years were invited to the Nord-Trøndelag Health (HUNT) Study (1984 to 1986) and 74,977 (88.1%) attended. The study included standardized measurements of blood pressure, body weight and height, and self-administered questionnaires. Participants who later had aneurysmal SAH (n=132) were identified, and hazard ratios (HRs), adjusted for age and sex, were estimated using Cox regression analysis. RESULTS: The crude annual incidence of aneurysmal SAH was 9.9 per 100,000 people; the incidence was almost twice as high in women as in men (12.9 versus 6.8, P=0.001). Systolic blood pressure was positively associated with risk (P for trend=0.001). Compared with the reference (<130 mm Hg), the adjusted HR in people with systolic blood pressure of 130 to 139 mm Hg was 2.3 (95% CI, 1.4 to 3.8) and for systolic blood pressure >170 mm Hg, the HR was 3.3 (95% CI, 1.7 to 6.3). Diastolic pressure showed similar positive associations. Compared with never smokers, former (HR, 2.7; 95% CI, 1.4 to 5.1) and current (HR, 6.1; 95% CI, 3.6 to 10.4) smokers had substantially higher risk. Compared with normal weight (body mass index, 18.5 to 24.9 kg/m(2)), overweight people were at lower risk (HR, 0.6; 95% CI, 0.4 to 1.0). CONCLUSIONS: Systolic and diastolic blood pressure were strong predictors of aneurysmal SAH, and there was a substantially increased risk associated with smoking. However, high body mass was associated with reduced risk of aneurysmal SAH.