Departments of Emergency Medicine.
Department of Intensive Care Medicine, Haga Hospital, The Hague.
Eur J Emerg Med. 2018 Oct;25(5):355-361. doi: 10.1097/MEJ.0000000000000457.
Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. The effects of epidemiological changes such as ageing of the population and increased traffic safety on the incidence of TBI are unknown.
The objective of this study was to evaluate trends in TBI-related emergency department (ED) visits, hospitalization and mortality in the Netherlands between 1998 and 2012.
This was a retrospective observational, longitudinal study.
The main outcome measures were TBI-related ED visits, hospitalization and mortality.
Between 1998 and 2012, there were 500 000 TBI-related ED visits in the Netherlands. In the same period, there were 222 000 TBI-related admissions and 17 000 TBI-related deaths. During this period, there was a 75% increase in ED visits for TBI and a 95% increase for TBI-related hospitalization; overall mortality because of TBI did not change significantly. Despite the overall increase in TBI-related ED visits, this increase was not evenly distributed among age groups or trauma mechanisms. In patients younger than 65 years, a declining trend in ED visits for TBI caused by road traffic accidents was observed. Among patients 65 years or older, ED visits for TBI caused by a fall increased markedly. TBI-related mortality shifted from mainly young (67%) and middle-aged individuals (<65 years) to mainly elderly (63%) individuals (≥65 years) between 1998 and 2012. The conclusions of this study did not change when adjusting for changes in age, sex and overall population growth.
The incidence of TBI-related ED visits and hospitalization increased markedly between 1998 and 2012 in the Netherlands. TBI-related mortality occurred at an older age. These observations are probably the result of a change in aetiology of TBI, specifically a decrease in traffic accidents and an increase in falls in the ageing population. This hypothesis is supported by our data. However, ageing of the population is not the only cause of the changes observed; the observed changes remained significant when correcting for age and sex. The higher incidence of TBI with a relatively stable mortality rate highlights the importance of clinical decision rules to identify patients with a high risk of poor outcome after TBI.
创伤性脑损伤(TBI)是全球发病率和死亡率的主要原因。人口老龄化和交通安全改善等流行病学变化对 TBI 发病率的影响尚不清楚。
本研究旨在评估 1998 年至 2012 年间荷兰 TBI 相关急诊科(ED)就诊、住院和死亡率的趋势。
这是一项回顾性观察性纵向研究。
TBI 相关 ED 就诊、住院和死亡率。
1998 年至 2012 年间,荷兰有 50 万例 TBI 相关 ED 就诊。同期,TBI 相关住院治疗有 22.2 万例,TBI 相关死亡有 1.7 万例。在此期间,TBI 的 ED 就诊人数增加了 75%,TBI 相关住院人数增加了 95%;总体 TBI 死亡率没有显著变化。尽管 TBI 相关 ED 就诊人数总体增加,但各年龄段和创伤机制之间的分布并不均匀。在 65 岁以下的患者中,道路交通伤害导致的 TBI 就诊人数呈下降趋势。在 65 岁及以上的患者中,跌倒导致的 TBI 就诊人数显著增加。TBI 相关死亡率从 1998 年至 2012 年,主要由年轻人(67%)和中年人(<65 岁)转变为老年人(63%)(≥65 岁)。在调整年龄、性别和总人口增长变化后,本研究的结论并未改变。
1998 年至 2012 年间,荷兰 TBI 相关 ED 就诊和住院人数显著增加。TBI 相关死亡率出现在较年长的年龄。这些观察结果可能是 TBI 病因变化的结果,特别是交通事故减少和人口老龄化导致跌倒增加。我们的数据支持这一假设。然而,人口老龄化并不是观察到的变化的唯一原因;当校正年龄和性别时,观察到的变化仍然显著。TBI 发病率增加而死亡率相对稳定,这突出了临床决策规则在识别 TBI 后预后不良风险较高的患者中的重要性。