Hanson Holly R, Gittelman Michael A, Pomerantz Wendy J
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 USA.
Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45255 USA.
Inj Epidemiol. 2019 May 29;6(Suppl 1):23. doi: 10.1186/s40621-019-0207-x. eCollection 2019.
Traumatic brain injuries (TBI) in children result in significant morbidity and mortality. There are many mechanisms, both sport and non-sport related, which cause these injuries. Studies have reported that Emergency Department (ED) visits for pediatric TBI caused by sports are increasing; however, no subsequent study has evaluated the trend in non-sport TBI. The objective of this study was to evaluate ED visits, admissions, and deaths for non-sport TBI compared to those caused by sports.
A retrospective study of children 5-19 years of age was performed at a pediatric, level 1 trauma center from 2002 to 2012. Subjects with a primary or secondary diagnosis of TBI were identified from the hospital's trauma registry, and mechanism of injury, disposition, injury severity score, and length of stay were recorded. Frequencies were used to characterize the population, Chi-square analysis was performed to determine differences between groups, and linear trend lines were calculated for sport-related and non-sport TBI by year.
Thirteen thousand two hundred ninty one subjects were seen in the ED between 2002 and 2012 for a TBI; 9527 (72%) were from a non-sport mechanism, and 3764 (28%) were from a sport mechanism. Subjects with a non-sport TBI were more likely to be younger ( < 0.001), African American ( < 0.001), and have Medicare/Medicaid ( < 0.001). Subjects with a non-sport TBI were admitted to the hospital 15% of the time, and subjects with a sport-related TBI were admitted 10% of the time ( < 0.001). When evaluating all TBI by mechanism of injury, sport had the lowest injury severity score (mean 4.4) and the shortest length of stay (mean 1.6 days) of any mechanism. There were six deaths reported from non-sport TBI and none from sport-related TBI. ED visits for sport-related TBI increased 92%, and non-sport TBI increased 22% over 10 years. There was a peak in TBI, in both groups, seen in 2009.
ED visits for both sport and non-sport TBI have increased over the past 10 years. TBI from a non-sport mechanism was more likely to result in hospitalization or death. Prevention efforts should be expanded to include all high-risk TBI mechanisms, not just sports.
儿童创伤性脑损伤（TBI）会导致显著的发病率和死亡率。有许多与运动和非运动相关的机制会导致这些损伤。研究报告称，因运动导致的儿科TBI到急诊科（ED）就诊的人数在增加；然而，后续没有研究评估非运动性TBI的趋势。本研究的目的是评估非运动性TBI与运动性TBI相比的急诊就诊、住院和死亡情况。
对2002年至2012年在一家一级儿科创伤中心5至19岁的儿童进行回顾性研究。从医院的创伤登记处确定患有原发性或继发性TBI诊断的受试者，并记录损伤机制、处置方式、损伤严重程度评分和住院时间。使用频率来描述人群特征，进行卡方分析以确定组间差异，并按年份计算与运动相关和非运动性TBI的线性趋势线。
2002年至2012年期间，有13291名受试者因TBI到急诊科就诊；9527名（72%）来自非运动机制，3764名（28%）来自运动机制。非运动性TBI的受试者更可能年龄较小（<0.001）、是非裔美国人（<0.001）且有医疗保险/医疗补助（<0.001）。非运动性TBI的受试者有15%的时间被收治入院，而与运动相关的TBI受试者有10%的时间被收治入院（<0.001）。按损伤机制评估所有TBI时，运动导致的损伤严重程度评分最低（平均4.4），住院时间最短（平均1.6天）。报告有6例非运动性TBI死亡，运动相关TBI无死亡病例。与运动相关的TBI的急诊就诊人数在10年内增加了92%，非运动性TBI增加了22%。两组在2009年出现TBI就诊高峰。
在过去10年中，运动性和非运动性TBI的急诊就诊人数均有所增加。非运动机制导致的TBI更有可能导致住院或死亡。预防措施应扩大到包括所有高风险的TBI机制，而不仅仅是运动方面。
