Prospective observational cohort study on epidemiology, treatment and outcome of patients with traumatic brain injury (TBI) in German BG hospitals.

OBJECTIVES: Since 2000/2001, no large-scale prospective studies addressing traumatic brain injury (TBI) epidemiology in Germany have been published. Our aim was to look for a possible shift in TBI epidemiology described in other European countries, to look for possible changes in TBI management and to identify predictors of 1-year outcome especially in patients with mild TBI. DESIGN: Observational cohort study. SETTING: All patients suffering from a TBI of any degree between 1 October 2014 and 30 September 2015, and who arrived in one of the seven participating BG hospitals within 24 hours after trauma, were included. PARTICIPANTS: In total, 3514 patients were included. OUTCOME MEASURES: Initial care, acute hospital care and rehabilitation were documented using standardised documentation forms. A standardised telephone interview was conducted 3 and 12 months after TBI in order to obtain information on outcome. RESULTS: Peaks were identified in males in the early 20s and mid-50s, and in both sexes in the late 70s, with 25% of all patients aged 75 or older. A fall was the most frequent cause of TBI, followed by traffic accidents (especially bicyclists). The number of head CT scans increased, and the number of conventional X-rays of the skull decreased compared with 2000/2001. Besides, more patients were offered rehabilitation than before. Though most TBI were classified as mild, one-third of the patients participating in the telephone interview after 12 months still reported troubles attributed to TBI. Negative predictors in mild TBI were female gender, intracranial bleeding and Glasgow Coma Scale (GCS) 13/14. CONCLUSION: The observed epidemiologic shift in TBI (ie, elderly patients, more falls, more bicyclists) calls for targeted preventive measures. The heterogeneity behind the diagnosis 'mild TBI' emphasises the need for defining subgroups not only based on GCS.

Predictors of outcome in head injury: proposal of a new scaling system.

BACKGROUND: In a statistical outcome analysis covering 10 years, 554 patients with isolated head trauma were analyzed. The aim of this study was to combine clinical and computed tomographic characteristics in a prognostic scoring system determining outcome after head injury. METHODS: After collection of data, mortality and morbidity were determined for each clinical and radiologic parameter; a different grading from 1 to 8 points was then attached to each parameter. The total score for each patient was calculated by adding the individual points from the different parameters. RESULTS: Significant differences in outcome (p < 0.01, Mann-Whitney U test) were registered in steps from 0 to 10 points (group I), 11 to 20 points (group II), and > 20 points (group III). Group I had a mortality of 8.3%, and patients in groups II and III died in 51.2% and 80.8%, respectively. Patients in group I had a Glasgow Outcome Scale (GOS) score of 4 and 5 in 19.4% and 56.7%, respectively, whereas group II reached a GOS score of 4 or 5 in only 9.9% and 1.7%, respectively. Patients in group III never reached a GOS score of 4 or 5. CONCLUSION: The presented scaling system allows a predictive value in mortality and morbidity to be determined for each patient suffering from brain trauma.