Backen Timbre, Salottolo Kristin, Acuna David, Palacio Carlos H, Berg Gina, Tsoris Andrea, Madayag Robert, Banton Kaysie, Bar-Or David
Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA.
Trauma Research Departments, Swedish Medical Center, Englewood, Colorado, USA.
Neurotrauma Rep. 2024 Oct 9;5(1):999-1008. doi: 10.1089/neur.2024.0097. eCollection 2024.
The aging US population has altered the epidemiology of traumatic injury, but there are few studies examining changing patterns of traumatic intracranial hemorrhage (tICH). We examined temporal changes in incidence, demographics, severity, management, and outcomes of tICH among trauma admissions at six US Level I trauma centers over 6 years (July 1, 2016-June 30, 2022). Patients with tICH (subdural, epidural, subarachnoid, and intracerebral hemorrhage) were identified by 10th revision of the International Statistical Classification of Diseases diagnosis codes. Temporal trends were examined over 12 six-month intervals using joinpoint regression and reported as biannual percent change (BPC); models without joinpoints are described as linear trends over time. There were 67,514 trauma admissions over 6 years and 11,935 (17.7%) patients had a tICH. The proportion of tICH injuries significantly increased 2.6% biannually from July 2016 to July 2019 (BPC = 2.6, = 0.04), then leveled off through June 2022 (BPC = -0.9, = 0.19). Similarly, the proportion of geriatric patients (≥65 years old) increased 2.4% biannually from July 2016 to July 2019 (BPC = 2.4, = 0.001) as did injuries due to falls (BPC = 2.2, = 0.01). Three of the four most prevalent comorbidities significantly increased: hypertension linearly increased 2.1% biannually, functional dependence increased 25.5% biannually through June 2019, and chronic anticoagulant use increased 19.0% biannually through June 2019 and then 3.1% thereafter. There were no trends in the rates of neurosurgical intervention (BPC = -0.89, = 0.40), ED Glasgow coma score 3-8 (BPC = -0.4, = 0.77), or presence of severe extracranial injuries (BPC = -0.7, = 0.45). In-hospital mortality linearly declined 2.6% biannually (BPC = 2.6, = 0.05); however, there was a 10.3% biannual linear increase in discharge to hospice care (BPC = 10.3, < 0.001). These results demonstrate the incidence of tICH admissions is temporally increasing, and the population is growing older with more comorbidities and injuries from falls. Yet, traumatic brain injury severity and neurosurgical management are unchanged. The shift from in-patient death to hospice care suggests an increased need for palliative care services.
美国人口老龄化改变了创伤性损伤的流行病学特征，但很少有研究探讨创伤性颅内出血（tICH）模式的变化。我们研究了6年（2016年7月1日至2022年6月30日）期间美国6家一级创伤中心创伤入院患者中tICH的发病率、人口统计学特征、严重程度、治疗及预后的时间变化。通过国际疾病分类第10版诊断编码识别tICH患者（硬膜下、硬膜外、蛛网膜下腔和脑内出血）。使用连接点回归分析12个半年期的时间趋势，并报告为半年变化百分比（BPC）；无连接点的模型描述为随时间的线性趋势。6年期间共有67514例创伤入院患者，其中11935例（17.7%）患有tICH。从2016年7月至2019年7月，tICH损伤的比例每年显著增加2.6%（BPC = 2.6，P = 0.04），然后在2022年6月之前趋于平稳（BPC = -0.9，P = 0.19）。同样，老年患者（≥65岁）的比例从2016年7月至2019年7月每年增加2.4%（BPC = 2.4，P = 0.001），因跌倒导致的损伤比例也是如此（BPC = 2.2，P = 0.01）。四种最常见的合并症中有三种显著增加：高血压每年线性增加2.1%，功能依赖在2019年6月之前每年增加25.5%，慢性抗凝药物使用在2019年6月之前每年增加19.0%，之后每年增加3.1%。神经外科干预率（BPC = -0.89，P = 0.40）、急诊格拉斯哥昏迷评分3 - 8分（BPC = -0.4，P = 0.77）或严重颅外损伤的发生率（BPC = -0.7，P = 0.45）均无趋势变化。住院死亡率每年线性下降2.6%（BPC = 2.6，P = 0.05）；然而，临终关怀出院率每年线性增加10.3%（BPC = 10.3，P < 0.001）。这些结果表明，tICH入院的发生率在时间上呈上升趋势且人群老龄化，合并症更多且跌倒损伤更多。然而，创伤性脑损伤的严重程度和神经外科治疗没有变化。从住院死亡向临终关怀的转变表明对姑息治疗服务的需求增加。
