Severe traumatic brain injury in Norway: impact of age on outcome.

OBJECTIVE: The aim of this study was to investigate the influence of age on mortality and 3-month outcome in a Norwegian cohort of patients with severe traumatic brain injury (TBI). METHODS: Norwegian residents ≥ 16 years of age who were admitted with a severe TBI to the country's 4 major trauma centres in 2009 and 2010 were included, as were adults (16- 64 years) and elderly patients (≥ 65 years). RESULTS: Half of the adult subjects and 84% of the elderly subjects were injured by falls. One-third of the adults and half of the elderly subjects were admitted to a local hospital before being transported to a regional trauma hospital. Subdural haematomas were more frequent in the elderly subjects. One-quarter of adults and two-thirds of the elderly subjects died within 3 months. At 3 months, 41% of the adult survivors were still in-patients, mainly in rehabilitation units (92%). Of the surviving elderly subjects, 14% were in-patients and none were in rehabilitation units. There was no difference in functional level for survivors at the 3-month follow-up. CONCLUSION: Old age is associated with fall-induced severe TBI and high mortality rates. Less intensive treatment strategies were applied to elderly patients in the present study despite high rates of haemorrhage. Few surviving elderly patients received rehabilitation at 3 months post-injury.

[Scandinavian guidelines for prehospital management of severe traumatic brain injury]. / Skandinaviske retningslinjer for prehospital håndtering av alvorlige hodeskader.

Head trauma is the cause the death for many young persons. The number of fatalities can be reduced through systematic management. Prevention of secondary brain injury combined with the fastest possible transport to a neurosurgical unit, have been shown to effectively reduce mortality and morbidity. Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region.

[Scandinavian guidelines on the pre-hospital management of traumatic brain injury]. / Skandinaviske kliniske retningslinjer for praehospital behandling af patienter med svaere hovedtraumer.

Head trauma causes the death of many young persons. The number of fatalities can be reduced through systematic management. Preventing secondary brain injury together with the fastest possible transport to a neurosurgical unit has been shown to be effective in reducing mortality and morbidity. Evidence-based guidelines already exist that focus on all steps in the management. This article, which was written by members of the Scandinavian Neurotrauma Committee, presents recommendations on the pre-hospital management of traumatic brain injury adapted to the infrastructure of Scandinavia.

Head injury mortality in the Nordic countries.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in Western countries. Effective management planning for these patients requires knowledge of TBI epidemiology. The purpose of this study was to describe and analyze the development of TBI mortality in the Nordic countries during the period 1987-2001. Data on TBI deaths were retrieved from the national official statistical agencies according to specified diagnostic codes. We also collected data on the number of operations for acute TBI in the year 2000 from all Nordic hospitals admitting trauma patients. Finland had about twice as high a TBI mortality rate as the other countries. Similarly, the Finnish incidence of acute TBI operations was nearly twice that of the other countries. The median TBI death rate for Finland was 21.2 per 100,000 per year, and for Denmark, Norway, and Sweden 11.5, 10.4, and 9.5, respectively. There were more male than female deaths in all countries. The mortality rate from extracranial injuries was relatively equal between the countries. We observed a sizeable reduction in TBI mortality rates for all countries, except in Finland. Younger age groups had the most pronounced decrease in TBI mortality rates. The oldest age group had the least favorable development of TBI mortality rates, and the mean age of TBI casualties increased substantially during the study period. This study demonstrates considerable differences in and between the Nordic countries regarding TBI mortality. Preventive measures and implementation of regional guidelines are needed to assure a positive development in the future.

[Deaths from traumatic brain injury in the Nordic countries, 1987-2000]. / Hodeskadedødsfall i Norden 1987-2000.

BACKGROUND: Traumatic brain injury (TBI) is the major cause of death among young adults in western countries. In the context of a joint Nordic initiative regarding future management of patients with severe TBI, it was of interest to look into the magnitude of the problem and the most recent developments. MATERIAL AND METHODS: We have conducted a survey of the epidemiological aspects of TBI deaths in Denmark, Finland, Norway and Sweden for the period 1987-2000. Data were retrieved from the official statistical agencies in the four countries. We have also collected data on the number of operations for acute TBI in the year 2000 from all Nordic hospitals admitting trauma patients. RESULTS: There were almost twice as many deaths from TBI in Finland as in the other Nordic countries. The median mortality rate in Finland was 21.2 per 100,000 per year. The corresponding figures for Denmark were 12.8, Norway 10.5 and Sweden 9.8. Finland also had almost twice as many operations for acute TBI with 10.0 per 100,000 per year, versus 5.1 in Denmark, 4.8 in Norway and 5.7 in Sweden. The mortality rate was about three times higher among males than among females. All countries except Finland had a significant reduction in TBI deaths during the study period. The mortality rate from injuries other than TBI was more or less the same in all four countries. INTERPRETATION: Our findings imply that there are twice as many severe TBIs and related deaths in Finland compared with the other Nordic countries.

Neurosurgical teleconsultations in northern Norway.

We carried out a prospective study of the effect of neurosurgical teleconsultations on patient management in northern Norway. The total number of teleradiology image transfers during an eight-month study period was 723. We recorded data on 99 (14%) of these teleconsultations, which concerned 92 patients; the remainder were transfers to other departments at our hospital and transfers of routine examinations from a small community hospital that did not have a radiologist. The neurosurgeon on call noted the clinical condition and response time for each consultation. The consequences of the teleconsultation and the eventual benefits of the image transfer were evaluated. All 10 referring hospitals in the region used the service. The median response time was 3 hours (range 1-21 hours) in emergency cases and 1 day (range 1-7 days) in ordinary consultations. The response time was significantly shorter for patients with head injuries (median 3 hours) than for those with intracranial tumours (median 24 hours). Image transfer was considered beneficial for the patient in 93% of the cases. Avoidance of unnecessary patient transfer, changes of treatment at the referring hospital on the advice of the neurosurgeon and initiation of emergency transfer occurred in 34%, 42% and 13% of cases, respectively. The results confirm that teleconsultations between referring hospitals and a regional neurosurgical service influence patient management and reduce the frequency of patient transfer.

[Bipolar head injury with global amnesia]. / Bipolar hodeskade med global amnesi.

We report the first case of bipolar head injury, that is, subsequent head injuries sustained near both poles of the Earth. The injury caused a true global amnesia with loss of memory for the journey around the globe. This case history illustrates how modern emergency services have reduced the hazards of polar exploration, and how a second impact after a primary head injury may cause life-threatening complications.

Pre- and inter-hospital transport of severely head-injured patients in rural Northern Norway.

The purpose of this study was to survey the time consumed during the pre- and inter-hospital transport of severely head injured patients in Northern Norway. All patients (n = 85) operated for an intracranial mass lesions within 48 h after injury during the 10-year period 1986-1995 were included in this retrospective analysis. Ambulance records, transfer notes, and hospital records were reviewed. The transport of patients was classified as either direct from the trauma scene to the University Hospital (direct admission group) or as an inter-hospital transfer (transfer group). Forty-seven (55%) patients were in the direct admission group, and 38 (45%) were transferred through another hospital. The majority of patients (81%) were transported by air ambulance. Median time from injury to arrival in the emergency room was 5 (1-44) h. Time necessary for transport was significantly (p < 0.001) shorter in the direct admission group (median 3 h) compared to the transfer group (median 8 h). The inter-hospital transfer time was < or = 3 h in 17%. Clearly, the advanced air ambulance service in Northern Norway makes rapid inter-hospital transfer possible despite extremely long geographical distances. Our findings indicate that this possibility is not always utilized.