Comparison of nine trauma scoring systems in prediction of inhospital outcomes of pediatric trauma patients: a multicenter study.

Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

The prevalence of helmet use in motorcyclists around the world: a systematic review and meta-analysis of 5,006,476 participants.

Road traffic injuries present a significant public health burden, especially in developing countries. This systematic review and meta-analysis synthesized global evidence on motorcycle helmet use prevalence by including 299 records across 249 articles involving 5,006,476 participants from 1982 to 2022. The findings revealed a declining trend in helmet use prevalence over the past four decades, with an overall prevalence of 48.71%. The meta-regression analysis did not find any statistically significant change in the overall prevalence. Subgroup analysis showed higher helmet use prevalence in observation/survey records (54.29%) compared to crashed patient records (44.84%). Riders/Motorcyclists demonstrated a higher likelihood of wearing helmets than passengers in both observation/survey records (62.61 vs. 28.23%) and crashed patient records (47.76 vs. 26.61%). Countries with mandatory helmet use laws had higher helmet usage prevalence compared to those without (52.26 vs. 37.21%). The African continent had the lowest helmet use rates, while Latin America and the Caribbean regions had higher rates. This study provides a comprehensive overview of global helmet use prevalence, emphasizing disparities between high and low-income countries, variations in law enforcement, and trends over four decades. Targeted interventions are necessary to improve helmet-wearing habits, especially among passengers and regions with low usage rates. Effective legislation and awareness campaigns are crucial for promoting helmet use and reducing road traffic injuries burden.

Road traffic injuries and associated mortality in the Islamic Republic of Iran.

Background: Road traffic accidents are a major public health problem globally, causing millions of injuries, deaths and disabilities, and a huge loss of financial resources, especially in low- and middle-income countries. Aim: To determine the incidence of road traffic injuries and associated mortality from 1997 to 2020 in the Islamic Republic of Iran. Methods: This retrospective study used data from the Legal Medicine Organization of the Islamic Republic of Iran to estimate the annual rates of road traffic injuries and associated mortality from 21 March 1997 to 20 March 2020. The data were analysed using STATA version 14 and the annual rates are reported per 100 000 population. Results: During the study period, 5 760 835 road traffic injuries and 472 193 deaths were recorded in the Islamic Republic of Iran. The mortality rate increased from 22.4 per 100 000 in 1997 to 40 per 100 000 in 2005 and decreased to 18.4 per 100 000 in 2020. The injury rate increased from 111.1 per 100 000 in 1997 to 394.9 per 100 000 in 2005. It decreased in 2006 and 2007 and increased from then until 2010, finally reaching 331.8 per 100 000 in 2020. The male to female ratio for road traffic mortality was 3.9 in 1997 and 4.6 in 2020. The case fatality rate was highest (20.1%) in 1997 and decreased to 5.6% in 2020. Conclusion: Continuous interventions are needed to reduce the burden of road traffic injuries and associated mortality in the Islamic Republic of Iran.

Comparing Predictive Utility of Head Computed Tomography Scan-Based Scoring Systems for Traumatic Brain Injury: A Retrospective Study.

This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) was used to determine the predictive utility of scoring systems. Subgroup analyses were performed among patients with head AIS scores > 1. A total of 996 patients were included, of whom 786 (78.9%) were males. In-hospital mortality, ICU admission, neurosurgical intervention, and prolonged total hospital length of stay (THLOS) were recorded for 27 (2.7%), 207 (20.8%), 82 (8.2%), and 205 (20.6%) patients, respectively. For predicting in-hospital mortality, all scoring systems had AUROC point estimates above 0.9 and 0.75 among all included patients and patients with head AIS > 1, respectively, without any significant differences. The Marshall and NIRIS scoring systems had higher AUROCs for predicting ICU admission and neurosurgery than the other scoring systems. For predicting THLOS ≥ seven days, although the NIRIS and Marshall scoring systems seemed to have higher AUROC point estimates when all patients were analyzed, five scoring systems performed roughly the same in the head AIS > 1 subgroup.

Prediction of In-Hospital Outcomes in Patients with Traumatic Brain Injury Using Computed Tomographic Scoring Systems: A Comparison Between Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems.

OBJECTIVE: This study aimed to compare the prognostic value of Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems (NIRIS) in predicting the in-hospital outcomes of patients with traumatic brain injury. METHODS: We identified 250 patients with traumatic brain injury in a retrospective single-center cohort from 2019 to 2020. Computed tomography (CT) scans were reviewed by two radiologists and scored according to three CT scoring systems. One-month outcomes were evaluated, including hospitalization, intensive care unit admission, neurosurgical procedure, and mortality. Logistic regression analysis was performed to identify scoring systems and outcome relationships. The best cutoff value was calculated using the receiver operating characteristic curve model. RESULTS: Eighteen patients (7.2%) died in the 1-month follow-up. The mean age and Glasgow Coma Scale of survivors differed significantly from nonsurvivors. Subarachnoid hemorrhage and compressed/absent cisterns were dead patients' most frequent CT findings. All three scoring systems had good discrimination power in mortality prediction (area under the receiver operating characteristic curve of the Marshall, Rotterdam, and NIRIS was 0.78, 0.86, and 0.84, respectively). Regarding outcome, three systems directly correlated with unfavorable outcome prediction. CONCLUSIONS: The Marshall, Rotterdam, and NIRIS are good predictive models for mortality and outcome prediction, with slight superiority of the Rotterdam in mortality prediction and the Marshall in intensive care unit admission and neurosurgical procedures.

Effective factors of improved helmet use in motorcyclists: a systematic review.

BACKGROUND: Road traffic injuries (RTI) are one of the most prominent causes of morbidity and mortality, especially among children and young adults. Motorcycle crashes constitute a significant part of RTIs. Policymakers believe that safety helmets are the single most important protection against motorcycle-related injuries. However, motorcyclists are not wearing helmets at desirable rates. This study systematically investigated factors that are positively associated with helmet usage among two-wheeled motorcycle riders. METHODS: We performed a systematic search on PubMed, Scopus, Web of Science, Embase, and Cochrane library with relevant keywords. No language, date of publication, or methodological restrictions were applied. All the articles that had evaluated the factors associated with helmet-wearing behavior and were published before December 31, 2021, were included in our study and underwent data extraction. We assessed the quality of the included articles using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. RESULTS: A total of 50 articles were included. Most evidence suggests that helmet usage is more common among drivers (compared to passengers), women, middle-aged adults, those with higher educations, married individuals, license holders, and helmet owners. Moreover, the helmet usage rate is higher on highways and central city roads and during mornings and weekdays. Travelers of longer distances, more frequent users, and riders of motorcycles with larger engines use safety helmets more commonly. Non-helmet-using drivers seem to have acceptable awareness of mandatory helmet laws and knowledge about their protective role against head injuries. Importantly, complaint about helmet discomfort is somehow common among helmet-using drivers. CONCLUSIONS: To enhance helmet usage, policymakers should emphasize the vulnerability of passengers and children to RTIs, and that fatal crashes occur on low-capacity roads and during cruising at low speeds. Monitoring by police should expand to late hours of the day, weekends, and lower capacity and less-trafficked roads. Aiming to enhance the acceptance of other law-abiding behaviors (e.g., wearing seat belts, riding within the speed limits, etc.), especially among youth and young adults, will enhance the prevalence of helmet-wearing behavior among motorcycle riders. Interventions should put their focus on improving the attitudes of riders regarding safety helmets, as there is acceptable knowledge of their benefits.

N-methyl-D-aspartate receptor antagonists in improving cognitive deficits following traumatic brain injury: a systematic review.

OBJECTIVE: To review the role of N-methyl-D-aspartate receptor (NMDAR) antagonists in managing post-TBI cognitive deficits. METHODS: A search of PubMed, Embase, and Cochrane was conducted on Jan 12, 2021 without publication date or language restriction. RESULTS: Forty-seven studies were included, involving 20 (42.6%) randomized controlled trials. Four (8.5%) studies had a low risk of bias (RoB), while 34 (72.3%) had unclear and nine (19.2%) had high RoB. Six NMDAR antagonists had been investigated: amantadine (n = 32), memantine (n = 4), magnesium (n = 4), traxoprodil (n = 3), selfotel (n = 2), and dextromethorphan (n = 2). CONCLUSION: Although some benefits were observed, there are still some concerns regarding the efficacy and safety of NMDAR antagonists in improving post-TBI cognitive deficits. Further research is required to examine whether (i) these agents, notably amantadine, could accelerate cognitive improvement and shorten the hospital stay, (ii) these agents affect different cognitive domains/subdomains in the same direction, (iii) an optimal therapeutic time window exists, (iv) a member of this drug class can be proved to be effective without interfering in non-excitotoxic actions of glutamate, (v) they can be more effective as part of combination therapies or in particular subgroups of patients with TBI.

Self-Service Registry Log Builder: A Case Study in National Trauma Registry of Iran.

BACKGROUND: Although the process-mining algorithms have evolved in the past decade, the lack of attention to extracting event logs from raw data of databases in an automatic manner is evident. These logs are available in a process-oriented manner in the process-aware information systems. Still, there are areas where their extraction is a challenge to address (e.g., trauma registries). OBJECTIVE: The registry data are recorded manually and follow an unstructured ad hoc pattern; prone to high noises and errors; consequently, registry logs are classified at a maturity level of one, and extracting process-centric information is not a trivial task therein. The experiences made during the event log building from the trauma registry are the subjects to be studied. RESULTS: The result indicates that the three-phase self-service registry log builder tool can withstand the mentioned issues by filtering and enriching the raw data and making them ready for any level of process-mining analysis. This proposed tool is demonstrated through process discovery in the National Trauma Registry of Iran, and the encountered challenges and limitations are reported. CONCLUSION: This tool is an interactive visual event log builder for trauma registry data and is freely available for studies involving other registries. In conclusion, future research directions derived from this case study are suggested.

Trauma Registry Data as a Policy-Making Tool: A Systematic Review on the Research Dimensions.

Objective: To review the research dimensions of trauma registry data on health policy making. Methods: PubMed and EMBASE were searched until July 2020. Keywords were used on the search process included Trauma, Injury, Registry and Research, which were searched by using appropriate search strategies. The included articles had to: 1. be extracted from data related to trauma registries; 2- be written in English; 3- define a time period and a patient population; 4- preferably have more details and policy recommendations; and 5- preferably have a discussion on how to improve diagnosis and treatment. The results obtained from the included studies were qualitatively analyzed using thematic synthesis and comparative tables. Results: In the primary round of search, 19559 studies were retrieved. According to PRISMA statement and also performing quality appraisal process, 30 studies were included in the final phase of analysis. In the final papers' synthesis, 14 main research domains were extracted and classified in terms of the policy implication and research priority. The domains with the highest frequency were "The relationship between trauma registry data and hospital care protocols for trauma patients" and "The causes of Disability Adjusted Life Years (DALYs) due to trauma". Conclusion: Using trauma registry data as a tool for policy-making could be helpful in several ways, namely increasing the quality of patient care, preventing injuries and decreasing their number, figuring out the details of socioeconomic status effects, and improving the quality of researches in practical ways. Also, follow-up of patients after trauma surgery as one of the positive effects of the trauma registry can be the focus of attention of policy-making bodies.

Barriers and factors associated with the use of helmets by Motorcyclists: A scoping review.

Road Traffic Injuries (RTIs) have imposed a great global burden on public health. Motorcyclists and pedestrians comprise the most significant proportion of this burden. Several studies have demonstrated a link between helmet wearing and a decline in the impact of RTIs in motorcyclists. In this study, we aimed to review the barriers to helmet utilization by motorcyclists. This scoping review has been conducted in accordance with the guidelines for the systematic review of observational studies and the PRISMA Checklist. The search was conducted by using related keywords in EMBASE, PubMed, Scopus, and Cochrane Library. Four independent reviewers carried out the screening. The main outcomes of interest were barriers to helmet usage among motorcyclists, drawn from the finally included studies. Fifty-three records were selected for data extraction. According to these reports, the barriers and factors associated with helmet usage among motorcyclists were categorized into five entities as: legislations/enforcement strategies, helmet disadvantages (discomfort, visual/auditory blockage, and thermal dysregulation), risky behaviors (riding while drunk or high on drugs), sex and/or age factors, and the location and time of the injury event (rural vs. urban locations, day vs. night riding). From the perspective of policymakers, the findings of this review are of utmost importance and could be used in addressing the challenge of inadequate compliance with helmet use.

The Impact of Psychological First aid Training on the Providers: A Systematic Review.

OBJECTIVE: The consensus is that psychological first aid is a practical, early psychosocial intervention to mitigate the distress caused by disasters. This review aimed to investigate PFA training's efficacy in the existing studies and evaluate these programs' impact on trainees. METHODS: MEDLINE (National Library of Medicine, Bethesda, MD), EMBASE (Elsevier, Amsterdam, Netherlands), PsycInfo (American Psychological Association, Washington, DC), and Cochrane Library (John Wiley & Sons, Hobken, NJ, USA) were searched on August 1, 2020 without language and date limitation. The Cochrane Risk of Bias tool for randomized controlled trials and the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) (Cochrane, London, UK) were used to assess the quality of the studies included. SPSS (IBM Corp., Endicott, NY, USA) was used for descriptive, comparative, and correlational summaries. RESULTS: From 376 articles, only 9 studies met the criteria and were included after screening. The most common outcome was knowledge improvement, followed by increased confidence, and competence. Other outcomes encompassed Attitude, preparedness, and therapeutic engagement. CONCLUSION: PFA is the most suggested early intervention aftermath and could be acquired by professionals and non-professionals in the mental health area. Nonetheless, to obtain the desired outcome, PFA training programs' quality is vital. This review revealed that most training programs' duration was short, without scenario-based interactions and post-training supervisions. More controlled trials are required to measure the effectiveness of PFA training on the providers.

Predictive Utility of the Glasgow Coma Scale and the Head Abbreviated Injury Scale in Traumatic Brain Injury: Results from the National Trauma Registry of Iran.

BACKGROUND: Trauma severity indices are commonly used to describe the severity of sustained injuries in a quantitative manner perceivable by healthcare providers in different settings. In this study, we aimed to assess the predictive utility of the Glasgow Coma Scale (GCS) and the 2015 revision of the head Abbreviated Injury Scale (head AIS) as two of the most widely used severity indices for traumatic brain injury (TBI). METHODS: In this cross-sectional study, we used data from the National Trauma Registry of Iran. The area under the receiver operating characteristic curve (AUROC) was calculated to assess the utility of GCS and head AIS scores in predicting patients' outcomes. RESULTS: A total of 321 patients, predominantly males (81.9%) with an average age of 41.9 (±19.5) years were enrolled in the study. The most common cause of injury was road traffic accidents (73.5%) followed by falls (20.2%). The mean admission GCS and head AIS scores were 13.5 (±3.2) and 2.5 (±1.0), respectively. AUROC of the GCS was significantly higher than the head AIS for all outcome variables (P<0.05). AUROC of both severity scoring systems for predicting in-hospital mortality was significantly higher in the 15-44 age group than the 65 or older age group (P<0.05). CONCLUSION: Based on our study results, GCS had better performance in predicting patients' outcomes than the head AIS. Also, we found that age significantly affected the ability of these indices in predicting in-hospital mortality of TBI patients.

A minimum data set for traumatic brain injuries in Iran.

PURPOSE: Traumatic brain injury (TBI) is one of the major public health concerns worldwide. Developing a TBI registry could facilitate characterizing TBI, monitoring the quality of care, and quantifying the burden of TBI by collecting comparable and standardized epidemiological and clinical data. However, a national standard tool for data collection of the TBI registry has not been developed in Iran yet. This study aimed to develop a national minimum data set (MDS) for a hospital-based registry of patients suffering from TBI in Iran. METHODS: The MDS was designed in 2 phases, including a literature review and a Delphi study with content validation by an expert panel. After the literature review, a comprehensive list of administrative and clinical items was obtained. Through a two-round e-Delphi approach conducted by invited experts with clinical and research experience in the field of TBI, the final data elements were selected. RESULTS: A MDS of TBI was assigned to 2 parts: administrative part with 5 categories including 52 data elements, and clinical part with 9 categories including 130 data elements. CONCLUSION: For the first time in Iran, we developed a MDS specified for TBI consisting of 182 data elements. The MDS would facilitate implementing a TBI's national level registry and providing essential, comparable and standardized information.

How Can Policymakers be Encouraged to Support People With Spinal Cord Injury-Scoping Review.

STUDY DESIGN: Scoping review. OBJECTIVE: Regarding that inappropriate medical care approaches, absence of rehabilitation services, and existing barriers in physical, social, and policy environments lead to poor outcomes in individuals with spinal cord injury (SCI) and provision for appropriate interventions and care must be created by health policymakers, we conducted this scoping review to investigate how policymakers can be persuaded to set new plans for individuals with SCI. METHODS: This review was performed according to Arksey and O'Malley's framework. PubMed was searched in February2019 without language limitation. We looked for other potential gray literature sources and some professional websites. References sections of selected articles were also scanned for other relevant literature. RESULTS: We included literature that met inclusion criteria to answer our research question. The literature was divided into 3 categories. The first category included economic impact of SCI. The second category included the role of research and developing research strategy. The third category included effective interaction and communication with policymakers. CONCLUSION: It is essential to consider multiple factors for influencing policymakers' decisions. These factors include knowing how to communicate with policymakers and presenting constructive ideas, providing a source of valid, reliable, and consistent data, considering the role of patients' advocacy groups and Non-Governmental Organizations (NGOs), and presentation of the importance of early intervention in reducing healthcare system costs. Ultimately, the goal is to have a comprehensive and flexible plan for influencing policymakers.

Reasons for delayed spinal cord decompression in individuals with traumatic spinal cord injuries in Iran: A qualitative study from the perspective of neurosurgeons.

PURPOSE: The median time from the event leading to the spinal cord injury (SCI) to the time of decompressive surgery is estimated to be 6.9 days in Iran, which is much longer than the proposed ideal time (less than 24 h) in published guidelines. The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons. METHODS: This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons. RESULTS: The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews. Overall, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons. Other notable factors include delay in transferring patients to the trauma center, delay in availability of necessary equipment, and scarce medical personnel. CONCLUSION: In the perspective of neurosurgeons, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.

The impact of data quality assurance and control solutions on the completeness, accuracy, and consistency of data in a national spinal cord injury registry of Iran (NSCIR-IR).

STUDY DESIGN: Descriptive study. OBJECTIVE: This study aimed to develop and evaluate a systematic arrangement for improvement and monitoring of data quality of the National Spinal Cord (and Column) Injury Registry of Iran (NSCIR-IR)-a multicenter hospital-based registry. SETTING: SCI community in Iran. METHODS: Quality assurance and quality control were the primary objectives in improving overall quality of data that were considered in designing a paper-based and computerized case report. To prevent incorrect data entry, we implemented several validation algorithms, including 70 semantic rules, 18 syntactic rules, seven temporal rules, and 13 rules for acceptable value range. Qualified and trained staff members were also employed to review and identify any defect, inaccuracy, or inconsistency in the data to improve data quality. A set of functions were implemented in the software to cross-validate, and feedback on data was provided by reviewers and registrars. RESULTS: Socio-demographic data items were 100% complete, except for national ID and education level, which were 97% and 92.3% complete, respectively. Completeness of admission data and emergency medical services data were 100% except for arrival and transfer time (99.4%) and oxygen saturation (48.9%). Evaluation of data received from two centers located in Tehran proved to be 100% accurate following validation by quality reviewers. All data was also found to be 100% consistent. CONCLUSIONS: This approach to quality assurance and consistency validation proved to be effective. Our solutions resulted in a significant decrease in the number of missing data.

The effectiveness of different types of motorcycle helmets - A scoping review.

BACKGROUND: Protective helmets may reduce the risk of death and head injury in motorcycle collisions. However, there remains a large gap in knowledge regarding the effectiveness of different types of helmets in preventing injuries. OBJECTIVE: To explore and evaluate the effectiveness of different types of motorcycle helmets; that is the association between different helmet types and the incidence and severity of head, neck, and facial injuries among motorcyclists. Also, to explore the effect of different helmet types on riders. METHODS: A systematic search of different scientific databases was conducted from 1965 to April 2019. A scoping review was performed on the included articles. Eligible articles were included regarding defined criteria. Study characteristics, helmet types, fixation status, retention system, the prevention of injury or reduction of its severity were extracted. RESULTS: A total of 137 studies were included. There was very limited evidence for the better protection of full-face helmets from head and facial injury compared to open-face and half-coverage helmets. There was however scarce evidence for the superiority of a certain helmet type over others in terms of protection from neck injury. The retention system and the fixation status of helmets were two important factors affecting the risk of head and brain injury in motorcyclists. Helmets could also affect and limit the riders in terms of vision, hearing, and ventilation. Multiple solutions have been discussed to mitigate these effects. CONCLUSION: Full-face helmets may protect head and face in motorcycle riders more than open-face and half-coverage helmets, but there is not enough evidence for better neck protection among these three helmet types. Helmets can affect the rider's vision, hearing, and ventilation. When designing a helmet, all of these factors should be taken into account.

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran.

PURPOSE: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. METHODS: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. RESULTS: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003). CONCLUSION: Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

Biofluid Biomarkers in Traumatic Brain Injury: A Systematic Scoping Review.

Emerging evidence suggests that biofluid-based biomarkers have diagnostic and prognostic potential in traumatic brain injuries (TBI). However, owing to the lack of a conceptual framework or comprehensive review, it is difficult to visualize the breadth of materials that might be available. We conducted a systematic scoping review to map and categorize the evidence regarding biofluid-based biochemical markers of TBI. A comprehensive search was undertaken in January 2019. Of 25,354 records identified through the literature search, 1036 original human studies were included. Five hundred forty biofluid biomarkers were extracted from included studies and classified into 19 distinct categories. Three categories of biomarkers including cytokines, coagulation tests, and nerve tissue proteins were investigated more than others and assessed in almost half of the studies (560, 515, and 502 from 1036 studies, respectively). S100 beta as the most common biomarker for TBI was tested in 21.2% of studies (220 articles). Cortisol was the only biomarker measured in blood, cerebrospinal fluid, urine, and saliva. The most common sampling time was at admission and within 24 h of injury. The included studies focused mainly on biomarkers from blood and central nervous system sources, the adult population, and severe and blunt injuries. The most common outcome measures used in studies were changes in biomarker concentration level, Glasgow coma scale, Glasgow outcome scale, brain computed tomography scan, and mortality rate. Biofluid biomarkers could be clinically helpful in the diagnosis and prognosis of TBI. However, there was no single definitive biomarker with accurate characteristics. The present categorization would be a road map to investigate the biomarkers of the brain injury cascade separately and detect the most representative biomarker of each category. Also, this comprehensive categorization could provide a guiding framework to design combined panels of multiple biomarkers.