Severe neurotrauma in Switzerland: have short-term outcomes improved?

Neurotrauma has a high incidence in high-income countries (790 per 100,000 population per year) and can be considered a silent epidemic. Severe traumatic brain injury (TBI) is a major burden for societies and is associated with high costs for both immediate and long-term care. Population-based studies including patients with severe TBI are rare. A recent cohort study in Switzerland observed an incidence of 11 / 100,000 population / year. Mortality rate at 14 days post-injury was 30% in Switzerland and was associated with the severity of the injury and the age of the injured person. Thirty-five percent of patients were >65 years; in this subpopulation the incidence (22/100,000/year) and death rate (41%) were higher; this high proportion of elderly patients in this setting is new. A decrease in disability in the first year after TBI was observed in large multicentre cohort studies including the Swiss cohort study. There is some evidence that the speed of decrease of disability over time is associated with intensive neurorehabilitation. In conclusion, short-term outcome may have improved for younger patients over recent years, but this improvement may be masked by the higher proportion of elderly patients with less favourable outcomes. Additionally, we propose that clinical pathways from the prehospital period to rehabilitation could be improved, and in turn allow a higher level of positive outcomes not only in young but also in elderly patients.

Severe traumatic brain injury in a high-income country: an epidemiological study.

This adult cohort determined the incidence and patients' short-term outcomes of severe traumatic brain injury (sTBI) in Switzerland and age-related differences. A prospective cohort study with a follow-up at 14 days was performed. Patients ≥16 years of age sustaining sTBI and admitted to 1 of 11 trauma centers were included. sTBI was defined by an Abbreviated Injury Scale of the head (HAIS) score >3. The centers participated from 6 months to 3 years. The results are presented as percentages, medians, and interquartile ranges (IQRs). Subgroup analyses were performed for patients ≤65 years (younger) and >65 (elderly). sTBI was observed in 921 patients (median age, 55 years; IQR, 33-71); 683 (74.2%) were male. Females were older (median age, 67 years; IQR, 42-80) than males (52; IQR, 31-67; p<0.00001). The estimated incidence was 10.58 per 100,000 inhabitants per year. Blunt trauma was observed in 879 patients (95.4%) and multiple trauma in 283 (30.7%). Median Glasgow Coma Score (GCS) on the scene was 9 (IQR 4-14; 8 in younger, 12 in elderly) and in emergency departments 5 (IQR, 3-14; 3 in younger, 8 in elderly). Trauma mechanisms included the following: 484 patients with falls (52.6%; younger, 242 patients [50.0%]; elderly, 242 [50.0%]), 291 with road traffic accidents (31.6%; younger, 237 patients [81.4%]; elderly, 54 [18.6%]), and 146 with others (15.8%). Mortality was 30.2% (24.5% in younger, 40.9% in elderly). Median GCS at 14 days was 15 (IQR, 14-15) without differences among subgroups. Estimated incidence of sTBI in Switzerland was low, age was high, and mortality considerable. The elderly had higher initial GCS and a higher death rate, but high GCS at 14 days.