Jussi Puljula

Head trauma sustained under the influence of alcohol is a predictor for future traumatic brain injury: A long-term follow-up study

Hazardous drinking may result in recurrent head trauma. It was investigated whether head trauma sustained under the influence of alcohol is a predictor of future traumatic brain injury (TBI).

Incidence of moderate‐to‐severe traumatic brain injuries after reduction in alcohol prices

Alcohol may be involved in 40–50% of traumatic brain injuries (TBI). In Finland, the cutting of alcohol taxes by one third in 2004 resulted in a marked increase in per capita alcohol consumption. We investigated the consequences of increased alcohol consumption on the incidence of moderate‐to‐severe traumatic brain injury among a defined population.

Mild traumatic brain injury diagnosis frequently remains unrecorded in subjects with craniofacial fractures.

BACKGROUND Traumatic brain injuries (TBI) in subjects with craniofacial fractures are usually diagnosed by emergency room physicians. We investigated how often TBI remains unrecorded in these subjects, and whether diagnostic accuracy has improved after the implementation of new TBI guidelines. METHODS All subjects with craniofacial fractures admitted to Oulu University Hospital in 1999 and in 2007 were retrospectively identified. New guidelines for improving the diagnostic accuracy of TBI were implemented between 2000 and 2006. Clinical symptoms of TBI were gathered from notes on hospital charts and compared to the recorded diagnoses at discharge. Logistic regression was used to identify independent predictors for TBI to remain unrecorded. RESULTS Of 194 subjects with craniofacial fracture, 111(57%) had TBI, 40 in 1999 and 71 in 2007. Fifty-one TBIs (46%) remained unrecorded at discharge, 48 being mild and 3 moderate-to-severe. Subjects with unrecorded TBI were significantly less frequently referred to follow-up visits. Failures to record the TBI diagnosis were less frequent (29/71, 41%) in 2007 than in 1999 (22/40, 55%), but the difference was not statistically significant. The most significant independent predictor for this failure was the clinical specialty (other than neurology/neurosurgery) of the examining physician (p<0.001). The subjects alcohol intoxication did not hamper the diagnosis of TBI. CONCLUSIONS TBIs remain frequently unrecorded in subjects with craniofacial fractures. Recording of mild TBI slightly but insignificantly improved after the implementation of new guidelines.

Predictors of new-onset seizures: a 10-year follow-up of head trauma subjects with and without traumatic brain injury

Background It is not known whether alcohol-related head trauma predicts the new-onset seizures, particularly alcohol-related seizures. Objective We investigated risk factors for new-onset seizures in a cohort of 739 head trauma subjects. Methods All subjects with head trauma attending Oulu University Hospital during 1999, including children and very old people but excluding persons with previous seizures and/or neurological diseases, were enrolled and followed up until the end of 2009. The Finnish National Hospital Discharge Register was used to identify all visits due to seizures during the 10-year follow-up. Dates of death were obtained from the official Cause-of-Death Statistics. Cox proportional hazard regression models and Kaplan-Meier survival curves were used to identify predictors of new-onset seizures. Results New-onset seizures were observed in 42 out of the 739 subjects (5.7%). An alcohol-related index injury (adjusted HR 2.50, 95% CI 1.30 to 4.82, p=0.006), moderate-to-severe traumatic brain injury (TBI) as the index trauma (3.13, 1.46 to 6.71, p=0.003) and preceding psychiatric disease (3.23, 1.23 to 9.21, p=0.028) were significant predictors of new-onset seizures during the follow-up after adjustment for age and sex. An alcohol-related index injury was the only independent predictor of the occurrence of an alcohol-related new-onset seizure (adjusted HR 12.13, 95% CI 2.70 to 54.50, p=0.001), and these seizures (n=19) developed more frequently among subjects without (n=14) than with (n=5) TBI. Conclusions We conclude that alcohol-related head trauma predicts new-onset seizures, particularly alcohol-related seizures. A brief intervention is needed in order to prevent the development of alcohol-related seizures.

Mortality from traumatic brain injury after reduction of alcohol prices: A population-based study from northern Finland

Aims: Traumatic brain injury (TBI) is the leading cause of death after trauma, and alcohol is a major risk factor for TBI. In Finland, alcohol taxes were cut by one third in 2004. This resulted in a marked increase of alcohol consumption. We investigated whether increased alcohol consumption influenced the number of fatal TBIs. Methods: All (n = 318) fatal TBIs were identified from medico-legal reports during the years 1999, 2006 and 2007 among the residents of Oulu Province, Finland. Mortality rates were compared before and after alcohol price reduction. Alcohol involvement based on the presence of alcohol in body fluids and/or alcohol-related diseases recorded in death certificates. Results: The proportion of alcohol-related TBI deaths of all TBI deaths increased (from 1999 to 2007) among middle-aged people from 48% to 91% (p = 0.001) but decreased among young adults from 74% to 41% (p = 0.015). The overall TBI mortality rate did not increase. Fatal TBIs due to falls were significantly more commonly alcohol-related in 2006–2007 than in 1999 (p = 0.003) and accumulated among middle-aged people. Conclusions: After the price reduction, alcohol-related fatal TBIs increased most among middle-aged people, and they were frequently caused by fall accidents. The reduction of alcohol prices did not increase the total number of fatal TBIs. Middle-aged and elderly subjects with TBI should be routinely asked for alcohol drinking and those with hazardous drinking habits should be guided for alcohol intervention.

Mortality of harmful drinkers increased after reduction of alcohol prices in northern Finland: a 10-year follow-up of head trauma subjects

Objective: Alcohol-related mortality may be influenced by the level of alcohol consumption. We investigated the effect of alcohol price reduction on mortality in a cohort of 827 subjects with head injury. Methods: We used the Finnish National Hospital Discharge Register to identify all diagnoses recorded during hospital and health center visits for survivors of the index injury during a follow-up of 10 years. Mortality data were gathered from death records obtained from the Official Cause-of-Death Statistics. Cox proportional hazards model was used to identify independent predictors for death. Kaplan-Meier survival curves were used to characterize the effect of alcohol price reduction on mortality of harmful and non-harmful drinkers. Results: Alcohol-related deaths increased after the reduction of alcohol prices on March 1, 2004. Subjects recorded as harmful drinkers during the follow-up period were significantly (p < 0.001) more likely than others to die after the price reduction. Older age (HR 1.06, 95% CI 1.05–1.07), moderate-to-severe brain injury (HR 2.39, 95% CI 1.59–3.60) and harmful drinking recorded after the index trauma (HR 2.59, 95% CI 1.62–4.62) were significant (p < 0.001) predictors for death. Conclusion: We conclude that a political decision to lower the price of alcohol may cause a significant increase in the death rate of harmful drinkers.

Head trauma with or without mild brain injury increases the risk of future traumatic death: a controlled prospective 15-year follow-up study

Patients who have recovered from traumatic brain injury (TBI) show an increased risk of premature death. To investigate long-term mortality rates in a population admitted to the hospital for head injury (HI), we conducted a population-based prospective case-control, record-linkage study, All subjects who were living in Northern Ostrobothnia, and who were admitted to Oulu University Hospital in 1999 because of HI (n=737), and 2196 controls matched by age, gender, and residence randomly drawn from the population of Northern Ostrobothnia were included. Death rate and causes of death in HI subjects during 15 years of follow-up was compared with the general population controls. The crude mortality rates were 56.9, 18.6, and 23.8% for subjects having moderate-to-severe traumatic brain injury (TBI), mild TBI, and head injury without TBI, respectively. The corresponding approximate annual mortality rates were 6.7%, 1.4%, and 1.9%. All types of index HI predicted a significant risk of traumatic death in the future. Subjects who had HI without TBI had an increased risk of both death from all causes (hazard ratio 2.00; 95% confidence interval 1.57-2.55) and intentional or unintentional traumatic death (4.01, 2.20-7.30), compared with controls. The main founding was that even HI without TBI carries an increased risk of future traumatic death. The reason for this remains unknown and further studies are needed. To prevent such premature deaths, post-traumatic therapy should include an interview focusing on lifestyle factors.

Mortality of subjects with alcohol-related seizures increased after alcohol cheapening.

To investigate whether the reduction of alcohol prices in Finland (March 1, 2004) associated with an increase in mortality of subjects with alcohol‐related seizures.

Risk for All-cause and Traumatic Death in Head Trauma Subjects: A Prospective Population-based Case-control Follow-up Study.

Objective:To investigate long-term mortality for subjects with acute head trauma. Background:It is not known why long-term mortality after head trauma without traumatic brain injury is elevated. Methods:All subjects admitted to Oulu University Hospital emergency room in 1999 with an acute head trauma (n = 737) were followed up until February 2014 and compared with age and sex-matched general population controls (n = 2196). Dates and causes of death were obtained from the official Cause-of-Death Statistics. Cox proportional hazard regression models and Kaplan-Meier survival curves were used to identify predictors for alcohol-related, nonalcohol-related, and all-cause death. Results:Alcohol-related deaths were more frequent among the subjects with head trauma (27.8%) than among the population controls (6.9%). Head trauma with or without traumatic brain injury (TBI) shortened mean life expectancy by 8.7 years and by as much as 13 years if only those without TBI were considered. The risk of alcohol-related death was 7-fold (hazard ratio 6.79; 95% confidence interval, 3.94–11.71) among subjects without TBI as compared with general population. Of all future deaths among these cases 17.1% were because of a new trauma, a significantly higher frequency (P < 0.005) than that observed in the general population (3% of all deaths). Alcohol-related cause of death was significantly more common among the subjects who were under the influence of alcohol at the time of the index trauma than among the sober subjects. Conclusions:Head trauma subjects without TBI have an elevated risk of alcohol-related death. Alcohol-related traumas are a major cause of death among these subjects.

Contents Vol. 39, 2012

177 2nd International Congress on Neurology and Epidemiology Nice, France, November 8–10, 2012 Editors: Feigin, V.L. (Auckland); Giroud, M. (Dijon)