Alexandra Brazinova

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Epidemiology of traumatic brain injury in Europe

BackgroundTraumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence and outcome of TBI necessary. We aimed to describe the epidemiology of traumatic brain injury in Europe and to evaluate the methodology of incidence studies.MethodWe performed a systematic review and meta-analyses of articles describing the epidemiology of TBI in European countries. A search was conducted in the PubMed electronic database using the terms: epidemiology, incidence, brain injur*, head injur* and Europe. Only articles published in English and reporting on data collected in Europe between 1990 and 2014 were included.ResultsIn total, 28 epidemiological studies on TBI from 16 European countries were identified in the literature. A great variation was found in case definitions and case ascertainment between studies. Falls and road traffic accidents (RTA) were the two most frequent causes of TBI, with falls being reported more frequently than RTA. In most of the studies a peak TBI incidence was seen in the oldest age groups. In the meta-analysis, an overall incidence rate of 262 per 100,000 for admitted TBI was derived.ConclusionsInterpretation of published epidemiologic studies is confounded by differences in inclusion criteria and case ascertainment. Nevertheless, changes in epidemiological patterns are found: falls are now the most common cause of TBI, most notably in elderly patients. Improvement of the quality of standardised data collection for TBI is mandatory for reliable monitoring of epidemiological trends and to inform appropriate targeting of prevention campaigns.

Severe Traumatic Brain Injury in Austria II: Epidemiology of hospital admissions

ZusammenfassungZIELE: Das Ziel der vorliegenden Arbeit ist es, anhand von Spitalsaufnahmen die Epidemiologie von Patienten mit schwerem Schädelhirntrauma (SHT) darzustellen. PATIENTEN UND METHODEN: Es standen Datensätze von 492 Patienten zur Verfügung, die von 5 österreichischen Zentren in die Studie inkludiert worden waren. Alters- und Geschlechtsverteilung, Ausbildung, Beruf, Unfallort und-mechanismus, Alkoholisierung, Art und Schweregrad des Traumas, Begleitverletzungen, sowie Dauer und Ergebnis der Intensivbehandlung wurden für jedes der beteiligten Zentren evaluiert. ERGEBNISSE: Die Stichprobe repräsentiert ungefähr 13% aller Fälle von schwerem SHT, welche während des Studienzeitraums in österreichischen Spitälern behandeltwurden. Das mittlere Alter betrug 48 ± 21 Jahre, und die Mehrzahl (72%) der Patienten war männlich. Die Unfälle ereigneten sich am häufigsten auf der Straße (50%), zu Hause (44%), in freier Natur (10%) und am Arbeitsplatz (7%). Verkehrsunfall (44%), Sturz (< 3 m; 30%), Fall (> 3 m; 11%) und Sportunfall (5%) waren die häufigsten Ursachen. Unter den Verkehrsunfällen waren Autolenker und -beifahrer am häufigsten (45%) betroffen, gefolgt von Fußgängern (20%), Motorradfahrern (19%) und Radfahrern (16%). Für die meisten der untersuchten Variablen fanden sich signifikante Unterschiede zwischen den Zentren. Das SHT war in 10% mit einer Rückenmarksverletzung und in 38% mit anderen schweren Verletzungen kombiniert. Die Intensivstations-Mortalität betrug 31,7%. Zwischen Unfallmechanismus und Verletzungsschwere oder Behandlungsergebnis fanden sich keine signifikanten Korrelationen. SCHLUSSFOLGERUNGEN: Die Epidemiologie des schweren SHT in Österreich ist nicht sehr verschieden von der in anderen Industrieländern. Die häufigste Ursache ist der Verkehrsunfall, was die Bedeutung der Verhütung dieser Unfälle aufzeigt. Die spezifischen Risken Älterer und die Verhütung von Unfällen im häuslichen Bereich verdienen besondere Beachtung.SummaryOBJECTIVES: The goal of this paper is to describe the hospital-based epidemiology of severe TBI in Austria. PATIENTS AND METHODS: Data sets from 492 patients included in the study by 5 Austrian hospitals were available. Age and gender distribution, education, occupation, location of trauma, mechanism of injury, alcohol use, type and severity of injury, associated injuries, length of intensive care unit stay, and intensive care unit outcome were evaluated for each of the 5 centers. RESULTS: The sample represents roughly 13% of all cases with severe TBI which were treated in Austrian hospitals during the study period. Mean age was 48 ± 21 years, and most patients were male (72%). The most important trauma locations were roads (50%), home (24%), outdoors (10%), and workplace (7%). Transportrelated trauma was the most important mechanism (44%) followed by falls < 3 m (30%), falls > 3 m (11%), and sports injuries (5%). Detailed analysis of transport-related trauma showed that car accidents (45%) were most common, followed by pedestrian (20%), motorbike (19%), and bicycle (16%) accidents. Significant differences between the centers were found for most of the variables analyzed. The severe traumatic brain injury was associated with spinal cord injury in 10%, and with severe multiple trauma in 38% of cases. Intensive care mortality was 31.7%. There were no significant correlations between mechanisms of injury and severity of trauma, nor between mechanisms and ICU outcome. CONCLUSIONS: Epidemiology of severe traumatic brain injuries in Austria is not much different from other industrialized countries. Traffic accidents are responsible for the majority of traumas, stressing the importance of road injury prevention. Attention should also be paid to the specific risks of older people and to prevent injuries at home.

Severity and outcome of traumatic brain injuries (TBI) with different causes of injury

Introduction: Most epidemiological studies and reports have reached a consensus on the leading causes of traumatic brain injury (TBI). Despite the fact that the area of TBI is relatively well studied, reports on differences in severity and outcome of TBI with different causes are lacking. Goal: This paper analyses the differences in severity and in short- and long-term outcome of TBIs with different causes. Method: This study analysed data on 1109 patients with severe TBI by dividing them into three injury-cause groups: ‘traffic-related’, ‘falls’ and ‘other causes’. Severity and outcome was evaluated using chosen direct and indirect indicators. Results: The most severe trauma occurred in the traffic-related group followed by falls and injuries with other causes. On the other hand, patients with traffic-related TBI had the best outcome. Age improves the outcome in the traffic-related group significantly. However, in the multivariate analysis after adjusting for age (and other important predictors including level of care) the odds for favourable long-term outcome stayed significantly higher in the traffic-related group. Conclusions: It is concluded that the causes of TBI should be considered by both clinicians and public health professionals as a lead in prognosis of outcome and policy planning.

Epidemiology of traumatic brain injury in Austria

SummaryBackgroundTraumatic 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.MethodsData 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.ResultsIncidence (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.ConclusionsThe high rate of geriatric TBI warrants better prevention of falls in this age group.ZusammenfassungZiel der StudieSchädelhirntraumen (SHT) sind eine relevante Ursache von potentiell verhinderbaren Todesfällen. Das Ziel der Studie war, Daten zur Epidemiologie des SHT in Österreich zu erheben.MethodikAngaben zu SHT-bedingten Spitalaufnahmen und Ambulanzbesuchen sowie zu präklinischen und innerklinischen Todesfällen für die Jahre 2009–2011 wurden von verschiedenen Institutionen zur Verfügung gestellt. Angaben zur Bevölkerung (Geschlechtsverteilung, Altersgruppen, Einwohnerzahlen der österreichischen Gemeinden) der Jahre 2009–2011wurden von der Webseite der „Statistik Austria“ heruntergeladen. Inzidenz, Letalität, und Mortalität wurden für die gesamte Population sowie für Altersgruppen errechnet.ErgebnisseInzidenz (303/100.000/Jahr), Letalität (3,6 %), und Mortalität (11/100.000/Jahr) des SHT in Österreich entsprechen den Werten, die für andere europäische Länder erhoben wurden. Auffällig war die hohe Anzahl von geriatrischen SHT-Fällen. Das Verhältnis zwischen männlichen und weiblichen Fällen betrug 1,4:1 insgesamt, und betrug 2,2:1 in Fällen mit letalem Ausgang. Der häufigste Unfallmechanismus war Fall/Sturz; Verkehrsunfälle machten nur 7 % der Fälle aus. Männer verstarben häufiger durch Verkehrsunfälle und Selbstmorde, Frauen verstarben häufiger durch Fall/Sturz. Letalität und Mortalität nahmen mit zunehmendem Alter zu. Die Letalität war höher bei Patienten aus Regionen mit geringer Bevölkerungsdichte. In Regionen mit einem Krankenhaus, das SHT-Fälle versorgt, war die Mortalität niedriger als in Regionen ohne solches.SchlussfolgerungenDie hohe Rate an SHT-Fällen durch Fall/Sturz bei geriatrischen Patienten legt nahe, dass hier Präventionsmaßnahmen dringend erforderlich sind.

Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis

INTRODUCTION Traumatic brain injuries (TBI) are a major medical and socioeconomic problem. We aimed to estimate the hospital-based incidence, population-wide mortality, and the contribution of TBI to injury-related mortalities in European countries, and to provide European summary estimates for these indicators. METHODS For this cross-sectional analysis, we obtained population data from Eurostat for hospital discharges and causes of death in European countries in 2012. Outcomes of interest were TBIs that required hospital admission or were fatal. We calculated age-adjusted hospital discharge rates and mortality rates and extrapolated data to 28 European Union countries and all 48 states in Europe. We present between-country comparisons, pooled age-adjusted rates, and comparisons with all-injury rates. FINDINGS In 2012, 1 375 974 hospital discharges (data from 24 countries) and 33 415 deaths (25 countries) related to TBI were identified. The pooled age-adjusted hospital discharge rate was 287·2 per 100 000 (95% CI 232·9-341·5) and the pooled age-adjusted mortality rate was 11·7 per 100 000 (9·9-13·6). TBI caused 37% (95% CI 36-38) of all injury-related deaths in the analysed countries. Extrapolating our results, we estimate 56 946 (95% CI 47 286-66 099) TBI-related deaths and 1 445 526 (1 172 996-1 717 039) hospital discharges occurred in 2012 in the European Union (population 508·5 million) and about 82 000 deaths and about 2·1 million hospital discharges in the whole of Europe (population 737 million). We noted substantial between-country differences. INTERPRETATION TBI is an important cause of death and hospital admissions in Europe. The substantial between-country differences observed warrant further study and suggest that the true burden of TBI in Europe has not yet been captured. Rigorous epidemiological studies are needed to fully quantify the effect of TBI on society. Despite a great degree of consistency in data reporting across countries already being achieved, further efforts in this respect could improve the validity of between-country comparisons. FUNDING European Union, FP7.

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 of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field.

Objective To investigate the outcome of brain trauma patients who had a Glasgow Coma Scale score (GCS) of 3 and bilateral fixed and dilated pupils (BFDP) in the field. Methods Between January 2001 and December 2005, 13 European centres enrolled patients with severe brain trauma. Data sets of all patients who had a GCS of 3 as well as BFDP were analysed. Patients were classified according to the Glasgow Outcome Scale, 12 months after trauma as ‘good’ (Glasgow Outcome Scale of 5 or 4) or ‘poor’ functional recovery; relevant data for these two groups were compared. Variables that showed differences in univariate analyses (χ2 and Wilcoxon–Mann–Whitney tests) were then used as covariates in logistic regression models. A P value of less than 0.05 was considered significant. Results Ninety-two (7.8%) of 1172 patients had a GCS of 3 and BFDP; eight had ‘good’, 84 had ‘poor’ recovery. We found no significant differences in sex (79% male), age (median 32 years), and trauma mechanisms. Trauma was significantly less severe, probability of survival significantly higher (0.48 vs. 0.23) in the ‘good’ group. Only one of 39 patients who had closed basal cisterns on the first computed tomography scan, and none of the patients with midline shift greater than 15 mm had good outcomes. Logistic regression revealed that age, trauma severity, and status of basal cisterns on the first computed tomography scan were the factors determining outcomes. Conclusion Patients with a GCS of 3 and BFDP in the field should be resuscitated aggressively, especially if the trauma seems to be not too severe.

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.