Tracheostomy is associated with decreased hospital mortality after moderate or severe isolated traumatic brain injury.

BACKGROUND: Data regarding the impact and timing of tracheostomy in patients with isolated traumatic brain injury (TBI) are ambiguous. Our goal was to evaluate the impact of tracheostomy on hospital mortality in patients with moderate or severe isolated TBI. MATERIALS AND METHODS: We performed a retrospective cohort analysis of data prospectively collected at 87 Austrian intensive care units (ICUs). All patients continuously admitted between 1998 and 2010 were evaluated for the study. In total, 4,735 patients were admitted to ICUs with isolated TBI. Of these patients, 2,156 had a moderate or severe TBI (1,603 patients were endotracheally intubated only, 553 patients underwent tracheostomy). Epidemiological data (trauma severity, treatment, and outcome) of the two groups were compared. RESULTS: Patients with moderate or severe isolated TBI undergoing tracheostomy had a similar Glasgow Coma Scale score, median (interquartile range): 6 (3-8) vs 6 (3-8); p = 0.90, and Simplified Acute Physiology Score II, 45 (37-54) vs 45 (35-56); p = 0.86, compared with intubated patients not undergoing tracheostomy. Furthermore, patients undergoing tracheostomy exhibited higher Abbreviated Injury Scale Head scores and had a longer ICU stay for survivors, 30 (22-42) vs 9 (3-17) days; p < 0.0001). In contrast, risk-adjusted mortality was lower in patients undergoing tracheostomy compared with patients who remained intubated, observed-to-expected mortality ratio (95 % confidence interval): 0.62 (0.53-0.72) vs 1.00 (0.95-1.05) respectively. CONCLUSIONS: Despite the greater severity of head injury, patients with isolated TBI who underwent tracheostomy had a lower risk-adjusted mortality than patients who remained intubated. Reasons for this difference in outcome may be multifactorial and require further investigation.

Epidemiology of traumatic spinal cord injuries in Austria 2002-2012.

PURPOSE: The aim of this study was to analyse the epidemiological patterns (mortality, incidence of non-fatal cases and overall incidence), of traumatic spinal cord injuries (TSCI) in 2002-2012 in Austria. METHODS: TSCI-related deaths and hospital admissions in Austria 2002-2012 were obtained from Statistics Austria and analysed. Mortality rates, as well as non-fatal and overall incidence rates were calculated and compared across the age spectrum and by sex. Additionally, the main causes and demographic characteristics of victims were analysed. RESULTS: The crude overall incidence rate of TSCI was 16.96, CI 95 % 16.95-16.97 and the standardized incidence rate was 13.98, CI 95 % 13.97-13.99 per million (annual average rate). An annual increase in fatality rates was observed occurring mostly in the age group >65 years (Kendall's Tau = 0.1). Falls (mortality rate 19.58, CI 95 % 19.57-19.59) and injuries at home (incidence rate 56.57, CI 95 % 56.56-56.58) were the principal causes of fatal and non-fatal TSCI, respectively. Injuries to the neck region were the most common. All indicators were the highest for the age group >65 years: non-fatal incidence rate 23.55, CI 95 % 23.54-23.56; mortality rate 21.4, CI 95 % 21.39-21.41; and overall incidence rate 47.9, CI 95 % 47.89-47.91. A clear male dominance was observed (incidence rate ratio 1.9, CI 95 % 1.4-2.7). CONCLUSION: The population >65 years has been at the highest risk of TSCI in Austria for the analysed period and therefore preventive activities should be focused on this group. The increasing overall incidence of TSCI was driven by the increasing mortality rates that were highest in the age group >65 years. We advocate harmonization of epidemiological reporting especially regarding aetiology of TSCI in order to better inform policy makers and prevention.

Unintentional fall-related mortality in the elderly: comparing patterns in two countries with different demographic structure.

OBJECTIVES: Falls are among the major external causes of unintentional injury and injury-related mortality in the elderly. The aim of this study was to compare the patterns of unintentional fall-related mortalities in two countries with different demographic structure: Slovakia and Austria in 2003-2010. METHODS: A study was conducted using death certificate data, trends of fall-related mortality in the elderly (over 65 years) in Austria and Slovakia were compared. Crude and age-standardised mortality rates were calculated. Rate ratios were used to quantify differences based on age, sex and country. The role of demographic structure and population ageing was considered. RESULTS: The annual average crude mortality for Slovakia was 28.82, for Austria 54.19 per 100,000 person-years. Increasing rates were observed towards higher age in both countries. Males had higher mortality than females (1.18 times higher in Austria, 2.4 higher in Slovakia). In ages over 75 years rates were significantly higher in Austria, compared to Slovakia. Injuries to head (in males) and hip (in females) were most commonly the underlying cause of death. The proportion of populations over 65 and over 80 and rate of their increase were higher in Austria than in Slovakia. CONCLUSIONS: We conclude that higher proportions of the elderly population of Austria could have contributed to the higher fall-related mortality rates compared to Slovakia, especially in females over 80 years. Our study quantified the differences between two countries with different structure of the elderly population and these findings could be used in planning future needs of health and social services and to plan prevention in countries where a rapid increase in age of the population can be foreseen.

Factors that may improve outcomes of early traumatic brain injury care: prospective multicenter study in Austria.

BACKGROUND: Existing evidence concerning the management of traumatic brain injury (TBI) patients underlines the importance of appropriate treatment strategies in both prehospital and early in-hospital care. The objectives of this study were to analyze the current state of early TBI care in Austria with its physician-based emergency medical service. Subsequently, identified areas for improvement were transformed into treatment recommendations. The proposed changes were implemented in participating emergency medical services and hospitals and evaluated for their effect. METHODS: 14 Austrian centers treating TBI patients participated in the study. Between 2009 and 2012 all patients with Glasgow Coma Scale score < 13 and/or AIS head > 2 within 48 h after the accident, were enrolled. Data were collected in 2 phases: in the first phase data of 408 patients were analyzed. Based on this, a set of recommendations expected to improve outcomes was developed by the study group and implemented in participating centers. Recommendations included time factors (transport to appropriate trauma center, avoiding secondary transfer), adequate treatment strategies (prehospital fluid and airway management, anesthesia, ventilation), monitoring (pulse oximetry and blood pressure monitoring in all patients, capnography in ventilated patients) for prehospital treatment. In the emergency department focus was on first CT scan as soon as possible, short interval between CT scan and surgery and early use of thrombelastometry to optimize coagulation. Following implementation of these recommendations, data on 325 patients were collected and analyzed in phase 2. Final analysis investigated the impact of the recommendations on patient outcomes. RESULTS: Patients in both data collection phases showed comparable demographic and injury severity characteristics. Treatment changes, especially in terms of fluid management, monitoring and normoventilation as well as thrombelastometry measurements were implemented successfully in phase 2, and led to significant improvement of patient outcomes. Hospital mortality was reduced from 31 % to 23 %. We found a lower rate of unfavorable outcomes, a significant increase in unexpected survivors and more patients with unexpected favorable outcomes as well. CONCLUSIONS: The results of this study clearly demonstrate that the outcomes of TBI patients can be improved with appropriate early care.

Epidemiology and patterns of transport-related fatalities in Austria 1980-2012.

OBJECTIVES: Transport-related accidents remain the largest single cause of death among people aged 15 to 29 in the European Union, and despite the decrease in number of fatalities from 1990 onwards they remain a significant public health problem. The aim of this article was to analyze the long-term trends and patterns of transport-related fatalities, identify the anatomic distribution of most significant injuries in different road users, and identify the primary populations at risk of transport-related death in Austria between 1980 and 2013. METHODS: Data on transport-related fatalities based on death certificates were obtained from Statistics Austria for the analyzed period. Crude and age-standardized mortality rates per 100,000 were calculated and broken down by age, gender, and month of death, and the anatomic distribution of most significant injuries were identified. Potential years of life lost before age 75 (PYLL-75) were used as a measure of public health impact. RESULTS: A total of 39,709 transport-related fatalities were identified for the studied years; 74% were males and the mean age was 42.1 years (range 0-103). A decrease in the number of fatalities (from 2018 in 1980 to 554 in 2012), mortality rates (from 26 in 1980 to 7 in 2012), and PYLL-75 (from 68,960 in 1980 to 14,931 in 2012) was observed. Introduction of major prevention milestones (compulsory use of seat belts or child restraints) may have contributed to this decrease. Men 16-24 years old were at the highest risk of transport-related death. Pedestrian victims were more likely to be women and car drivers and motorcyclists were more often men. Most fatal transport accidents occurred between the months of May and October and prevailingly in towns of fewer than 20,000 inhabitants. Injuries to the head were the most significant injuries in all user groups (>50% of cases in all road user types). Reduced mortality rates could translate into higher prevalence of long-term disabilities in survivors of transport accidents. CONCLUSIONS: Despite the decreasing trend observed, transport-related fatalities remain a serious public health issue in Austria. An increase in the mortality of motor vehicle drivers warrants more preventive action in this group. Further research is needed on other outcomes of transport accidents such as long-term disabilities to elucidate the true public health burden of transport accidents.

Glasgow coma scale motor score and pupillary reaction to predict six-month mortality in patients with traumatic brain injury: comparison of field and admission assessment.

The Glasgow Coma Scale (GCS) and pupillary reactivity are well-known prognostic factors in traumatic brain injury (TBI). The aim of this study was to compare the GCS motor score and pupillary reactivity assessed in the field and at hospital admission and assess their prognostic value for 6-month mortality in patients with moderate or severe TBI. We studied 445 patients with moderate or severe TBI from Austria enrolled to hospital in 2009-2012. The area under the curve (AUC) and Nagelkerke's R(2) were used to evaluate the predictive ability of GCS motor score and pupillary reactivity assessed in the field and at admission. Uni- and multi-variable analyses-adjusting for age, other clinical, and computed tomography findings-were performed using combinations of field and admission GCS motor score and pupillary reactivity. Motor scores generally deteriorated from the field to admission, whereas pupillary reactivity was similar. GCS motor score assessed in field (AUC=0.754; R(2)=0.273) and pupillary assessment at admission (AUC=0.662; R(2)=0.214) performed best as predictors of 6-month mortality in the univariate analysis. This combination also showed best performance in the adjusted analyses (AUC=0.876; R(2)=0.508), but the performance of both predictors assessed at admission was not much worse (AUC=0.857; R(2)=0.460). Field GCS motor score and pupillary reactivity at hospital admission, compared to other combinations of these parameters, possess the best prognostic value to predict 6-month mortality in patients with moderate-to-severe TBI. Given that differences in prognostic performance are only small, both the field and admission values of GCS motor score and pupillary reaction may be reasonable to use in multi-variable prediction models to predict 6-month outcome.

Severity, Causes and Outcomes of Traumatic Brain Injuries Occurring at Different Locations: Implications for Prevention and Public Health.

AIM: Traumatic brain injuries (TBI) are a major public health problem. Although they are well studied, information on some aspects, such as the place of occurrence, is limited. The aim of this study was to describe the patterns of severity, causes and outcomes of TBI occurring at different locations and to identify the primary populations at risk of suffering TBI at each of the analysed locations. METHODS: 1,818 patients with TBI admitted to hospitals in Austria, Slovakia, Croatia, Bosnia, and Macedonia were analysed. Primary populations at risk, injury severity and extent along with short/long-term outcomes were analysed for TBI at each location. RESULTS: The highest mean age (57.9 years, p<0.001) was observed in injuries at home. The distribution of injury causes across the group was significantly different (p<0.001), with falls (39%) and traffic accidents (30%) being predominant. TBI occurring on roads or highways were the most severe (mean ISS=32.5, p<0.001; mean GCS=7.8, p<0.001). Injuries at home had the worst outcome (50% mortality, p<0.001 and 70% unfavourable outcome, p<0.001) whereas TBI at sport facilities or outdoors had the best outcome (24% mortality, 44% unfavourable outcome). When adjusted for age and severity, TBI occurring at home had the highest odds of mortality (OR=3.12, 95% CI=1.86-5.25) and unfavourable outcome (OR=2.51, 95% CI=1.54-4.08), compared to sports facility and outdoors as a reference. CONCLUSIONS: TBI at different locations display distinctive patterns as to causes, severity, outcome and populations at risk. Location is therefore a relevant epidemiological aspect of TBI and we advocate its inclusion in future studies. Definitions of primary populations at risk at different locations could help in targeted public health actions.

Fatal traumatic brain injury in older adults in Austria 1980-2012: an analysis of 33 years.

BACKGROUND: traumatic brain injury (TBI) is a significant public health problem. Developed countries report a significant increase of TBI in older adults in the past decades. The objective of this study was to investigate the changes in TBI-related mortality in older Austrians (65 years or older) between 1980 and 2012 (33 years) and to identify possible causes for these changes. METHODS: data from Statistics Austria on mortality in Austria between 1980 and 2012 were screened and data on TBI-related mortality in adults aged 65 and older were extracted and analysed, based on the diagnostic codes of the International Classification of Diseases, 10th and 9th revision. Mortality rates were calculated for 5-year age groups; standardized mortality rates were calculated for the total. Mechanism of injury was analysed for all events, both sexes and individual age groups. RESULTS: between 1980 and 2012, 16,204 people aged 65 or older died from TBI in Austria; 61% of these were male. Fatal TBI cases and mortality rates increased in the oldest age groups (80 years or older). Half of the fatal TBI cases were caused by falls, 22% by traffic accidents and 17% by suicides. Rate of fall-related fatal TBI increased and rate of traffic accident-related fatal TBI decreased with age. CONCLUSION: preventive measures introduced in the past decades in the developed countries have contributed to a decrease in traffic injuries. However, falls in the older population are on the rise, mainly due to ageing of the population, throughout the reported period. It is important to take preventive measures to stop the epidemics of fall-related TBIs and fatalities in older adults.

Performance of IMPACT, CRASH and Nijmegen models in predicting six month outcome of patients with severe or moderate TBI: an external validation study.

BACKGROUND: External validation on different TBI populations is important in order to assess the generalizability of prognostic models to different settings. We aimed to externally validate recently developed models for prediction of six month unfavourable outcome and six month mortality. METHODS: The International Neurotrauma Research Organization - Prehospital dataset (INRO-PH) was collected within an observational study between 2009-2012 in Austria and includes 778 patients with TBI of GCS < = 12. Three sets of prognostic models were externally validated: the IMPACT core and extended models, CRASH basic models and the Nijmegen models developed by Jacobs et al - all for prediction of six month unfavourable outcome and six month mortality. The external validity of the models was assessed by discrimination (Area Under the receiver operating characteristic Curve, AUC) and calibration (calibration statistics and plots). RESULTS: Median age in the validation cohort was 50 years and 44% had an admission GSC motor score of 1-3. Six-month mortality was 27%. Mortality could better be predicted (AUCs around 0.85) than unfavourable outcome (AUCs around 0.80). Calibration plots showed that the observed outcomes were systematically better than was predicted for all models considered. The best performance was noted for the original Nijmegen model, but refitting led to similar performance for the IMPACT Extended, CRASH Basic, and Nijmegen models. CONCLUSIONS: In conclusion, all the prognostic models we validated in this study possess good discriminative ability for prediction of six month outcome in patients with moderate or severe TBI but outcomes were systemically better than predicted. After adjustment for this under prediction in locally adapted models, these may well be used for recent TBI patients.

Hospital admissions for traumatic brain injury of Austrian residents vs. of visitors to Austria.

BACKGROUND: The goal was to compare epidemiology of hospital admissions for traumatic brain injury (TBI) in Austrian residents vs. visitors to Austria. METHODS: Data on all hospital admissions due to TBI (ICD-10 codes S06.0-S06.9; years 2009-2011) was provided by the Austrian Statistical Office. Data on Austrian population and on tourism (visitor numbers, nights spent) was retrieved from www.statistik.at . Age, sex, mechanism of injury, season and mortality was analysed for Austrian residents vs. visitors. RESULTS: Visitors contributed 3.9% to the total population and 9.2% of all TBI cases. Incidence of hospital admissions was 292/100,000/year in Austrian residents and was 727/100,000/year in visitors. Male:female ratio was 1.39:1 in Austrian residents and 1.55:1 in visitors. Austrian cases were older than visitors' cases (mean age 41 vs. 28 years). Austrian cases were distributed evenly over the seasons, while 75% of the visitors' cases happened during winter and spring. The most frequently observed causes of TBI in Austrian residents were private accidents, while sports caused almost half of the visitors' cases. Hospital mortality was lower in visitors than in Austrian residents (0.8 vs. 2.1%). CONCLUSION: Sports-related TBI of visitors causes a significant workload for Austrian hospitals. Better prevention is warranted.

Deaths due to traumatic brain injury in Austria between 1980 and 2012.

BACKGROUND: To investigate changes in TBI mortality in Austria during 1980-2012 and to identify causes for these changes. METHODS: Statistik Austria provided data (from death certificates) on all TBI deaths from January 1980-December 2012. Data included year/month of death, age, sex, residency of the cases and mechanism of accident. Data regarding the size of the age groups was obtained from Statistik Austria. Mortality rates (MR; deaths/10(5) population/year) were calculated for male vs. female patients and for different age groups. Changes in mechanisms of TBI were evaluated. RESULTS: The MR decreased from 28.1 to 11.8 deaths/10(5) population/year. Traffic-related TBI deaths decreased from 62% to 9%. This caused a significant decrease in TBI deaths in younger age groups. Fall-related TBI deaths (mostly geriatric cases) remained unchanged. Falls became the leading cause; its rate increased from 22% to 64% of all TBI deaths. Thus, the mean age of fatal TBI cases increased by 20 years and the rate of cases aged <60 years decreased from 71% to 28%. Another important cause was suicide by firearms; its rate increased from 10% to 23% of all TBI deaths. CONCLUSIONS: These findings warrant better prevention of falls in the elderly and of suicides.

Effects of time of hospital admission on outcomes after severe traumatic brain injury in Austria.

BACKGROUND: The goal of this study was to compare outcomes of patients with severe traumatic brain injury (TBI) who had been admitted either during workdays from 7 a.m. to 7 p.m. ("regular service") or during any other time ("on-call service"). MATERIAL AND METHODS: Between March 2002 and April 2012, 17 Austrian centers enrolled TBI patients into two observational studies that focused on effects of guideline compliance (n = 400) and on prehospital and early hospital management (n = 777), respectively. Data on trauma severity, clinical status, treatment, and outcomes were collected prospectively. All patients with severe TBI (Glasgow Coma Scale score < 9) were selected for this analysis. Secondary transfers and patients with unsurvivable injuries were excluded. The International Mission for Prognosis and Analysis of Clinical Trials in TBI core model was used to estimate probabilities of hospital death and unfavorable long-term outcome (Glasgow Outcome Scale score < 4). Based on time of arrival, patients were assigned to groups "regular service" or "on-call service." RESULTS: Data from 852 patients were analyzed (413 "regular," 439 "on-call service"). "On-call" patients were younger (45 vs. 51 years, P < 0.001) and had a higher rate of alcohol intoxication (41 vs. 11 %, P < 0.001). Trauma severity was comparable; the probabilities of death and unfavorable outcome were identical. There were no differences regarding computed tomography findings or treatment. Hospital mortality (24 vs. 28 %, P = 0.191) and rate of patients with unfavorable outcome at 6 months (43 vs. 48 %, P = 0.143) were comparable. CONCLUSIONS: In Austria, the time of hospital admission has no influence on outcomes after severe TBI.

Long-term trends and patterns of fatal traumatic brain injuries in the pediatric and adolescent population of austria in 1980-2012: analysis of 33 years.

Traumatic brain injuries (TBIs) are of special concern in the pediatric and adolescent population because of high incidence, mortality, and potential years of life lost (PYLL). Knowledge on causes and mortality trends is essential for effective prevention. The aim of this study was to analyze the long-term trends and causes of TBI-related mortality between 1980 and 2012 in the pediatric and adolescent populations of Austria. Death certificate data on TBI-related deaths of children and adolescents 0-19 years of age and exact population numbers were obtained from the Austrian Statistical Office. Five age groups were created. Mortality trends and causes of TBI were analyzed. PYLL were used to indicate the public health impact. Of 5319 identified TBI-related deaths, 75% were male victims. The annual mortality rates per 100,000 between 1980 and 2012 decreased from 25 to 2.6 in males, from 8.5 to 1.0 in females, and from 16.9 to 1.8 in the total population. Those 15-19 years of age had the highest mortalities, followed by 0-2 years of age. Over 80% of deaths were caused by accidents, inflicted TBIs were most common in those 0-2 years of age, and traffic accidents in those 15-19 years of age. In the studied period, 295,793 PYLL could be attributed to TBIs. Measures to prevent traffic accidents contributed significantly to the decrease of mortality and PYLL, especially in 15- to 19-year-old men. Causes and trends of TBI-related mortality exhibit age-group-specific patterns, and this knowledge could contribute to planning further preventive action to reduce TBI fatalities in the studied population.

Epidemiology of traumatic brain injury in Austria.

BACKGROUND: Traumatic brain injury (TBI) is an important cause of preventable deaths. The goal of this study was to provide data on epidemiology of TBI in Austria. METHODS: Data on all hospital discharges, outpatients, and extra- as well as in-hospital deaths due to TBI were collected from various sources for the years 2009-2011. Population data (number of male/female people per age-group, population of Austrian cities, towns, and villages) for 2009-2011 were collected from the national statistical office. Incidence, case fatality rate(s) (CFR), and mortality rate(s) (MR) were calculated for the whole population and for age groups. RESULTS: Incidence (303/100,000/year), CFR (3.6 %), and MR (11/100,000/year) of TBI in Austria are comparable with those from other European countries. We found a high rate of geriatric TBI. The ratio between male and female cases was 1.4:1 for all cases, and was 2.2:1 for fatal cases. The most common mechanism was falls; traffic accidents accounted for only 7 % of the cases. Males died more frequently from traffic accidents and suicides, and females died more frequently from falls. CFRs and MRs increased with increasing age. CFRs were higher in patients from less populated areas, and MRs were lower in cases who lived closer to hospitals that admitted TBI. CONCLUSIONS: The high rate of geriatric TBI warrants better prevention of falls in this age group.

Impact of concomitant injuries on outcomes after traumatic brain injury.

BACKGROUND: Patients with traumatic brain injury (TBI) frequently have concomitant injuries; we aimed to investigate their impact on outcomes. METHODS: Between February 2002 and April 2010, 17 Austrian centers prospectively enrolled 863 patients with moderate and severe TBI into observational studies. Data on accident, treatment, and outcomes were collected. Patients who survived until intensive care unit (ICU) admission and had survivable TBI were selected, and were assigned to "isolated TBI" or "TBI + injury" groups. Six-month outcomes were classified as "favorable" if Glasgow Outcome Scale (GOS) scores were five or four, and were classified as "unfavorable" if GOS scores were three or less. Univariate statistics (Fisher's exact test, t test, χ(2)-test) and logistic regression were used to identify factors associated with hospital mortality and unfavorable outcome. RESULTS: Of the 767 patients, 403 (52.5 %) had isolated TBI, 364 (47.5 %) had concomitant injuries. Patients with isolated TBI had higher mean age (53 vs. 44 years, P = 0.001); hospital mortality (30.0 vs. 27.2 %, P = 0.42) and rate of unfavorable outcome (50.4 vs. 41.8 %, P = 0.02) were higher, too. There were no significant mortality differences for factors like age groups, trauma mechanisms, neurologic status, CT findings, or treatment factors. Concomitant injuries were associated with higher mortality (33.3 vs. 12.5 %, P = 0.05) in patients with moderate TBI, and were significantly associated with more ventilation, ICU, and hospitals days. Logistic regression revealed that age, Glasgow Coma Scale score, pupillary reactivity, severity of TBI and CT score were the main factors that influenced outcomes. CONCLUSIONS: Concomitant injuries have a significant effect upon the mortality of patients with moderate TBI. They do not affect the mortality in patients with severe TBI.

Barbiturates use and its effects in patients with severe traumatic brain injury in five European countries.

The guidelines for management of traumatic brain injury (TBI) recommend that high-dose barbiturate therapy may be considered to lower intracranial pressure (ICP) that is refractory to other therapeutic options. Lower doses of barbiturates may be used for sedation of patients with TBI, although there is no mention of this in the published guidelines. The goal of this study was to analyze the use of barbiturates in patients with severe TBI in the European centers where the International Neurotrauma Research Organization introduced guideline-based TBI management and to analyze the effects of barbiturates on ICP, use of vasopressors, and short- and long-term outcome of these patients. Data on 1172 patients with severe TBI were collected in 13 centers located in five European countries. Patients were categorized into three groups based on doses of barbiturates administered during treatment. Univariate and multivariate statistical methods were used to analyze the effects of barbiturates on the outcome of patients. Fewer than 20% of all patients with severe TBI were given barbiturates overall, and only 6% was given high doses. High-dose barbiturate treatment caused a decrease in ICP in 69% of patients but also caused hemodynamic instability leading to longer periods of mean arterial pressure <70 mm Hg despite increased use of high doses of vasopressors. The adjusted analysis showed no significant effect on outcome on any stage after injury.Thiopental and methohexital were equally effective. Low doses of thiopental and methohexital were used for sedation of patients without side effects. Phenobarbital was probably used for prophylaxis of post-traumatic seizures.

Traumatic brain injuries caused by traffic accidents in five European countries: outcome and public health consequences.

BACKGROUND: Road traffic accidents (RTAs) have been identified by public health organizations as being of major global concern. Traumatic brain injuries (TBIs) are among the most severe injuries and are in a large part caused by RTA. The objective of this article is to analyse the severity and outcome of TBI caused by RTA in different types of road users in five European countries. METHODS: The demographic, severity and outcome measures of 683 individuals with RTA-related TBI from Austria, Slovakia, Bosnia, Croatia and Macedonia were analysed. Five types of road users (car drivers, car passengers, motorcyclists, bicyclists and pedestrians) were compared using univariate and multivariate statistical methods. Short-term outcome [intensive care unit (ICU) survival] and last available long-term outcome of patients were analysed. RESULTS: In our data set, 44% of TBI were traffic related. The median age of patients was 32.5 years, being the lowest (25 years) in car passengers. The most severe and extensive injuries were reported in pedestrians. Pedestrians had the lowest rate of ICU survival (60%) and favourable long-term outcome (46%). Drivers had the highest ICU survival (73%) and car passengers had the best long-term outcome (59% favourable). No differences in the outcome were found between countries with different economy levels. CONCLUSION: TBI are significantly associated with RTA and thus, tackling them together could be more effective. The population at highest risk of RTA-related TBI are young males (in our sample median age: 32.5 years). Pedestrians have the most severe TBI with the worst outcome. Both groups should be a priority for public health action.

Outcome after severe brain trauma associated with epidural hematoma.

OBJECTIVE: The aim of this study was to identify factors contributing to outcomes after severe traumatic brain injury (TBI) associated with epidural hematoma (EDH). METHODS: Between 02/2002 and 4/2010 17 Austrian centers prospectively enrolled 863 patients with moderate and severe TBI into observational studies. Data on accident, treatment, and outcomes were collected. Data sets from patients who had severe TBI (=Glasgow Coma Scale score <9) and EDH were selected. Six-month outcomes were classified as "favorable" if Glasgow Outcome Scale (GOS) scores were 5 or 4, and were classified as "unfavorable" if GOS scores were 3 or less. The Rotterdam score was used to classify computed tomography (CT) findings; the scores published by Hukkelhoven et al. (J Neurotrauma 22:1025-1039, 2005) were used to estimate predicted rates of death and of unfavorable outcomes. Univariate (Fisher's exact test, t test, Chi(2)-test) and multivariate (logistic regression) statistics were used to identify factors associated with hospital mortality and favorable outcome. RESULTS: Of the 738 patients with severe TBI 159 (21.5 %) had EDH. Of these, 49 (30.8 %) died in the hospital, 21 (13.2 %) survived with unfavorable outcome, 82 (51.6 %) with favorable outcome; long-term outcome was unknown in 7 survivors (4.4 %). Mortality rates predicted by the Rotterdam score showed good correlation with observed mortality rates. According to the Hukkelhoven scores, observed/predicted ratios for mortality and unfavorable outcome were 0.94 and 0.97, respectively. Age, severity of TBI, and neurological status were the main factors influencing outcomes after severe TBI associated with EDH. We were unable to demonstrate significant effects of treatment factors.

Outcome of patients with severe brain trauma who were treated either by neurosurgeons or by trauma surgeons.

BACKGROUND: In Central Europe, patients with severe traumatic brain injury (TBI) are frequently treated by trauma surgeons rather than neurosurgeons. The objective of this study was to compare outcomes of patients with TBI by trauma surgeons or neurosurgeons. This study is a retrospective analysis of prospectively collected data. METHODS: Between January 2001 and December 2005, 10 centers enrolled 311 operatively treated patients with severe TBI and no significant other injuries into observational studies. Data on accident, treatment, and outcomes were collected. Using the Glasgow Outcome Scale, 1-year outcomes were classified as "favorable" (scores 5 and 4) or "unfavorable" (scores <4). Data from patients operated by trauma surgeons ("group T") were compared with those from patients operated by neurosurgeons ("group N") using univariate and multivariate statistics. The scores published by Hukkelhoven et al. were used to estimate expected rates of death and unfavorable outcomes. RESULTS: There were 191 patients in group N and 120 in group T. There were no significant differences regarding age, sex, and trauma mechanisms between the two groups. Patients from group N had significantly higher trauma severity. The observed versus expected hospital mortality ratio was 0.84 for group N and 0.97 for group T (p = 0.051). One-year outcome was better in group T (28% vs. 19% good recovery, 1.7% vs. 9.4% vegetative status; p = 0.017), whereas mortality was not different (43% in both groups). Multivariate analysis revealed that outcomes were influenced by age and severity of TBI, whereas surgical specialty and treatment factors had no effects. CONCLUSION: With respect to operatively treated patients with TBI, trauma surgeons and neurosurgeons achieve comparable results. LEVEL OF EVIDENCE: II.

Outcome after severe brain trauma due to acute subdural hematoma.

OBJECT: In this paper, the authors' goal was to identify factors contributing to outcomes after severe traumatic brain injury (TBI) due to acute subdural hematoma (SDH). METHODS: Between February 2002 and April 2010, 17 Austrian centers prospectively enrolled 863 patients with moderate and severe TBI into observational studies. Data regarding accident, treatment, and outcomes were collected. Data sets from patients who had severe TBI (Glasgow Coma Scale score < 9) and acute SDH were selected. Six-month outcomes were classified as "favorable" if the Glasgow Outcome Scale (GOS) scores were 5 or 4, and they were classified as "unfavorable" if GOS scores were 3 or less. The Rotterdam score was used to classify CT findings, and the scores published by Hukkelhoven et al. were used to estimate the predicted rates of death and of unfavorable outcomes. Univariate (Fisher exact test, t-test, chi-square test) and multivariate (logistic regression) statistics were used to identify factors associated with hospital mortality and favorable outcome. RESULTS: Of the 738 patients with severe TBI, 360 (49%) had acute SDH. Of these, 168 (46.7%) died in the hospital, 67 (18.6%) survived with unfavorable outcome, and 116 (32.2%) survived with favorable outcome. Long-term outcome was unknown in 9 survivors (2.5%). Mortality rates predicted by the Rotterdam CT score showed good correlation with observed mortality rates. According to the Hukkelhoven scores, observed/predicted ratios for mortality and unfavorable outcome were 1.09 and 1.02, respectively. CONCLUSIONS: Age, severity of TBI, and neurological status were the main factors influencing outcomes after severe TBI due to acute SDH. Nonoperative management was associated with significantly higher mortality.