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Severe Traumatic Brain Injury in a Large Canadian Health Region

Published online by Cambridge University Press:  02 December 2014

David A. Zygun
Affiliation:
Department of Critical Care Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada Department of Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada
Kevin B. Laupland
Affiliation:
Department of Critical Care Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada Department of Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada Department Pathology and Laboratory Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada
Walter J. Hader
Affiliation:
Department of Clinical Neurosciences, University of Calgary and the Calgary Health Region, Calgary, AB Canada
John B. Kortbeek
Affiliation:
Department of Critical Care Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada Department of Surgery, University of Calgary and the Calgary Health Region, Calgary, AB Canada
Christi Findlay
Affiliation:
Department of Surgery, University of Calgary and the Calgary Health Region, Calgary, AB Canada
Christopher J. Doig
Affiliation:
Department of Critical Care Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada Department of Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada Department of Community Health Sciences, University of Calgary and the Calgary Health Region, Calgary, AB Canada
S. Morad Hameed
Affiliation:
Department of Critical Care Medicine, University of Calgary and the Calgary Health Region, Calgary, AB Canada Department of Surgery, University of Calgary and the Calgary Health Region, Calgary, AB Canada
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Abstract

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Background:

Although severe traumatic brain injury (sTBI) is a devastating condition with tremendous public health implications, the epidemiology of this disease has not previously been described in Canada. We sought to define the incidence, risk factors and outcome of patients suffering sTBI in a large Canadian region.

Methods:

A population-based surveillance cohort design was utilized to identify all Calgary Heath Region residents who were victims of trauma with an injury severity score ³12. Subsequent application of a specific sTBI case definition defined the final cohort.

Results:

The annual incidence of sTBI was 11.4 per 100,000 population. The incidence of sTBI was significantly higher for males as compared to females [17.1 vs. 5.9 per 100,000; relative risk (RR) = 2.91, 95% confidence interval; 2.17, 3.94; p<0.0001]. There was a striking increase in the annual age specific population incidence of sTBI observed among those older than 74 years of age. The relative risk among the highest risk group of elderly (>85 years) males as compared to the lowest risk female group (50-64 years) was 19.78 (95% CI; 6.27, 62.3; p<0.0001). One hundred and eight patients died prior to hospital discharge for a mortality rate of 5.1 per 100,000 per year.

Conclusion:

Severe traumatic brain injury is common among residents of the Calgary Health Region and is associated with a high mortality rate. Males and the elderly are at the highest risk for acquiring sTBI and may represent target groups for preventive efforts.

Conclusion:

Les lÉsions cÉrÉbrales par traumatisme crânien sÉvère sont frÉquentes parmi les rÉsidents de la rÉgion sanitaire de Calgary et sont associÉes à une mortalitÉ ÉlevÉe. Les hommes et les personnes âgÉes sont les groupes les plus à risque et constituent des groupes cibles pour les interventions à visÉe prÉventive.

Résumé:

RÉSUMÉ: Introduction:

Bien que les lésions cérébrales sévères (LCS) causées par un traumatisme crânien aient des conséquences dévastatrices et un impact important en santé publique, l’épidémiologie de cette affection n’a jamais été décrite au Canada. Le but de cette étude est de déterminer l’incidence, les facteurs de risque et l’issue des patients atteints de lésions cérébrales traumatiques graves dans un grand territoire canadien.

Méthodes:

Une étude de cohorte a été utilisée pour identifier tous les résidents de la région sanitaire de Calgary qui ont été victimes d’un traumatisme dont le score de sévérité des lésions était de 12 ou plus. Les cas inclus dans la cohorte étaient ensuite sélectionnés selon une définition spécifique des LCS

Résultats:

L’incidence annuelle des LCS était de 11,4 par 100,000 de population. Elle était légèrement plus élevée pour les hommes, soit 17,1 par rapport à 5,9 pour les femmes et leur risque relatif était de 2,91 (IC 2,17 à 3,94; p < 0,0001). Chez les sujets de plus de 74 ans, on a observé une incidence élevée de traumatismes crâniens. Le risque relatif était de 19,78 (IC 6,27 à 62,3; p < 0,0001) dans le groupe ayant le niveau de risque le plus élevé, soit les hommes âgés (> 85 ans) comparé à celui des femmes ayant le risque le plus faible (50 à 64 ans). Cent huit patients sont morts pendant l’hospitalisation, soit un taux de mortalité annuelle de 5,1 par 100,000.

Conclusions:

Les lésions cérébrales par traumatisme crânien sévère sont fréquentes parmi les résidents de la région sanitaire de Calgary et sont associées à une mortalité élevée. Les hommes et les personnes âgées sont les groupes les plus à risque et constituent des groupes cibles pour les interventions à visée préventive.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2014

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