Division of Neurosurgery, Department of Surgery, St. Michael's Hospital; Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre; University of Toronto, Toronto, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
PLoS One. 2016 Jan 13;11(1):e0145469. doi: 10.1371/journal.pone.0145469. eCollection 2016.
To examine epidemiological trends of Traumatic Brain Injury (TBI) treated in the Emergency Department (ED), identify demographic groups at risk of TBI, and determine the factors associated with hospitalization following an ED visit for TBI.
A province-wide database was used to identify all ED visits for TBI in Ontario, Canada between April 2002 and March 2010. Trends were analyzed using linear regression, and predictors of hospital admission were evaluated using logistic regression.
There were 986,194 ED visits for TBI over the eight-year study period, resulting in 49,290 hospitalizations and 1,072 deaths. The age- and sex-adjusted rate of TBI decreased by 3%, from 1,013.9 per 100,000 (95% CI 1,008.3-1,010.6) to 979.1 per 100,000 (95% CI 973.7-984.4; p = 0.11). We found trends towards increasing age, comorbidity level, length of stay, and ambulatory transport use. Children and young adults (ages 5-24) sustained peak rates of motor vehicle crash (MVC) and bicyclist-related TBI, but also experienced the greatest decline in these rates (p = 0.003 and p = 0.005). In contrast, peak rates of fall-related TBI occurred among the youngest (ages 0-4) and oldest (ages 85+) segments of the population, but rates remained stable over time (p = 0.52 and 0.54). The 5-24 age group also sustained the highest rates of sports-related TBI but rates remained stable (p = 0.80). On multivariate analysis, the odds of hospital admission decreased by 1% for each year over the study period (OR = 0.991, 95% CI = 0.987-0.995). Increasing age and comorbidity, male sex, and ambulatory transport were significant predictors of hospital admission.
ED visits for TBI are involving older populations with increasingly complex comorbidities. While TBI rates are either stable or declining among vulnerable groups such as young drivers, youth athletes, and the elderly, these populations remain key targets for focused injury prevention and surveillance. Clinicians in the ED setting should be cognizant of factors associated with hospitalization following TBI.
III.
Cross-sectional.
研究在急诊部（ED）治疗的创伤性脑损伤（TBI）的流行病学趋势，确定有 TBI 风险的人群，并确定与 ED 就诊后住院相关的因素。
使用全省范围的数据库来识别 2002 年 4 月至 2010 年 3 月期间加拿大安大略省所有的 ED 就诊的 TBI 病例。使用线性回归分析趋势，使用逻辑回归评估住院的预测因素。
在 8 年的研究期间，共发生 986194 例 ED 就诊的 TBI，导致 49290 例住院和 1072 例死亡。年龄和性别调整后的 TBI 发生率下降了 3%，从每 100000 人 1013.9 例（95%CI 1008.3-1010.6）降至每 100000 人 979.1 例（95%CI 973.7-984.4；p = 0.11）。我们发现，年龄、合并症水平、住院时间和非卧床交通方式的使用呈上升趋势。儿童和年轻人（5-24 岁）发生机动车事故（MVC）和骑自行车者相关 TBI 的比例最高，但这些比例也呈最大幅度下降（p = 0.003 和 p = 0.005）。相比之下，跌倒相关 TBI 的发生率最高的人群是年龄最小（0-4 岁）和最大（85 岁以上）的人群，但随着时间的推移，这些比率保持稳定（p = 0.52 和 0.54）。5-24 岁年龄组也发生最高的运动相关 TBI 比率，但保持稳定（p = 0.80）。多变量分析显示，研究期间每年的住院几率降低 1%（OR = 0.991，95%CI = 0.987-0.995）。年龄增长和合并症、男性性别以及非卧床交通方式是住院的显著预测因素。
ED 就诊的 TBI 涉及年龄越来越大、合并症越来越复杂的人群。尽管年轻人（年轻司机、青年运动员和老年人）等弱势群体的 TBI 发生率稳定或下降，但这些人群仍然是重点关注的伤害预防和监测对象。ED 环境中的临床医生应注意 TBI 后住院的相关因素。
III。
横断面研究。
