Management of Head Trauma.

Traumatic brain injury (TBI) represents a heterogenous spectrum of disease. It is essential to rapidly assess a patient's neurologic status and implement measures to prevent secondary brain injury. Intracranial hypertension, a common sequela of TBI, is managed in a tiered and systematic fashion, starting with the least invasive and moving toward the most invasive. TBI has long-lasting effects on patients and their families and represents a substantial financial and social influence on society. Research regarding the prognosis and treatment of TBI is essential to limit the influence of this widespread disease.

Traumatic Brain Injury and Subsequent Risk of Brain Cancer in US Veterans of the Iraq and Afghanistan Wars.

Importance: While brain cancer is rare, it has a very poor prognosis and few established risk factors. To date, epidemiologic work examining the potential association of traumatic brain injury (TBI) with the subsequent risk of brain cancer is conflicting. Further data may be useful. Objective: To examine whether a history of TBI exposure is associated with the subsequent development of brain cancer. Design, Setting, and Participants: A retrospective cohort study was conducted from October 1, 2004, to September 20, 2019, and data analysis was performed between January 1 and June 26, 2023. The median follow-up for the cohort was 7.2 (IQR, 4.1-10.1) years. Veterans Affairs (VA) and Department of Defense (DoD) administrative data on 1 919 740 veterans from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium were included. Exposure: The main exposure of interest was TBI severity (categorized as mild, moderate or severe [moderate/severe], and penetrating). Main Outcomes and Measures: The outcome of interest was the development of brain cancer based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes in either the DoD/VA medical records or from the National Death Index. Results: After 611 107 exclusions (predominately for no encounter during the study period), a cohort including 1 919 740 veterans was included, most of whom were male (80.25%) and non-Hispanic White (63.11%). Median age at index date was 31 (IQR, 25-42) years. The cohort included 449 880 individuals with TBI (mild, 385 848; moderate/severe, 46 859; and penetrating, 17 173). Brain cancer occurred in 318 individuals without TBI (0.02%), 80 with mild TBI (0.02%), 17 with moderate/severe TBI (0.04%), and 10 or fewer with penetrating TBI (≤0.06%). After adjustment, moderate/severe TBI (adjusted hazard ratio [AHR], 1.90; 95% CI, 1.16-3.12) and penetrating TBI (AHR, 3.33; 95% CI, 1.71-6.49), but not mild TBI (AHR, 1.14; 95% CI, 0.88-1.47), were associated with the subsequent development of brain cancer. Conclusions and Relevance: In this cohort study of veterans of the Iraq and Afghanistan wars, moderate/severe TBI and penetrating TBI, but not mild TBI, were associated with the subsequent development of brain cancer.

A Multicenter Study on the Clinical Characteristics and Outcomes Among Children With Moderate to Severe Abusive Head Trauma.

INTRODUCTION: We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT. METHODS: We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients <5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT. RESULTS: 47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently < 2 years old (42, 89.4% vs 133, 38.6%, p < 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p < 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p < 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p < 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age <2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT. CONCLUSIONS: AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT. TYPE OF STUDY: Observational cohort study. LEVEL OF EVIDENCE: III.

The Impact of the COVID-19 Shelter-in-Place Order on Traumatic Brain Injuries in San Francisco, California.

BACKGROUND: In response to the COVID-19 pandemic, San Francisco, California issued a shelter-in-place (SIP) order in March 2020, during which emergency physicians noted a drop in trauma cases, as well as a change in traditional mechanisms of trauma. OBJECTIVES: Our objective was to determine the epidemiology of traumatic brain injury (TBI) pre- and post-COVID-19 SIP. METHODS: We reviewed the electronic medical record of the only trauma center in the city of San Francisco, to determine the number of and characteristics of patients with a diagnosis of head injury presenting to the emergency department between December 16, 2019 and June 16, 2020. Using chi-squared and Fisher's exact tests when appropriate, we compared pre- and post- COVID-19 lockdown epidemiology. RESULTS: There were 1246 TBI-related visits during the 6-month study period. Bi-weekly TBI cases decreased by 36.64% 2 weeks after the COVID-19 SIP and then increased to near baseline levels by June 2020. TBI patients during SIP were older (mean age: 53.3 years pre-SIP vs. 58.2 post-SIP; p < 0.001), more likely to be male (odds ratio 1.43, 95% confidence interval 1.14-1.81), and less likely to be 17 or younger (8.9% vs. 0.5%, pre- to post-SIP respectively, p = 0.003). Patients were less likely to be Hispanic (27.2% vs. 21.7% pre- to post-SIP, respectively, p = 0.029). The proportion of TBI visits attributable to cycling accidents increased (14.1% to 52.7%, p < 0.001), whereas those attributable to pedestrians involved in road traffic accidents decreased (37.2% to 12.7%, p = 0.003). CONCLUSIONS: Understanding the changing epidemiology of TBI during the COVID-19 pandemic can aid in immediate and future disaster resource planning.

The epidemiology of crib-related head injuries: A ten-year nationwide analysis.

INTRODUCTION: Falls from cribs resulting in head injury are understudied and poorly characterized. The purpose of this study was to advance current understanding of the prevalence, descriptive characteristics of injury victims, and the types of crib fall-related head injuries (CFHI) using queried patient cases from the National Electronic Injury Surveillance System (NEISS) database. METHODS: Using the US Consumer Product Safety Commission's System NEISS database, we queried all CFHIs among children from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of the incident, diagnoses, ED disposition, and sequelae were analyzed. The number of CFHI from all US EDs during each year was also collected from the database. RESULTS: There were an estimated 54,799 (95% CI: 30,228-79,369) total visits to EDs for CFHIs between 2012 and 2021, with a decrease in incidence of approximately 20% during the onset of the COVID-19 pandemic (2019: 5616 cases, 2020: 4459 cases). The annual incidence of injuries showed no significant trend over the 10-year study period. An available subset of 1782 cases of head injuries from approximately 100 EDs was analyzed, and 1442 cases were included in final analysis. Injuries were sorted into three primary categories: unspecified closed head injury (e.g., closed head injury, blunt head trauma, or traumatic brain injury), concussion, or open head injury and skull fracture. Unspecified closed head injuries were the most common of all head injuries (95.4%, 1376/1442). Open head injuries (14/1442, 0.97%) and concussions 3.6% (52/1442, 3.6%) were rare. Most injuries involved children under the age of 1 (42.6%) compared to children who were 1, 2, 3, or 4-years old. About a fourth of patients had other diagnoses in addition to their primary injury including scalp/forehead hematomas, emesis, and contusions. Female patients were more likely to present with other diagnoses in addition to their primary head injury (Difference: 12.3%, 95% CI: 9.87%-15.4%, p < .0001). CONCLUSION: Despite minimum rail height requirements set by the Consumer Safety Product Commission (CPSC), head injuries associated with crib falls are prevalent in the United States. However, most injuries were minor with a vast majority of patients being released following examination and treatment.

Epidemiology of Work-Related Traumatic Brain Injury and COVID-19 Pandemic Lockdown Consequences: Experience in a Reference Center in Chile.

INTRODUCTION: Work-related traumatic brain injury is a frequent cause of chronic morbidity, mortality, and high treatment costs. Its causes are highly environmentally determined and were affected by COVID-19 pandemic lockdowns. OBJECTIVE: We aimed to describe traumatic brain injury (TBI) epidemiology in working population and evaluate its modifications during the COVID-19 pandemic. METHODS: We performed a 2-year retrospective epidemiological analysis of TBI patients hospitalized in a tertiary work-related hospital before and during the COVID-19 pandemic. RESULTS: In the prepandemic period, TBI patients were predominantly men, with a bimodal age distribution. Crash accidents were the leading work-related traumatic brain injury cause. During COVID-19 pandemic lockdowns, there was a positive correlation between street traffic and TBI rate, presenting increased motor crash accidents as a cause of TBI. CONCLUSIONS: These results are relevant for planning and focalization of resources for TBI prevention.

Adolescent alcohol and cannabis use as risk factors for head trauma in the Northern Finland Birth Cohort study 1986.

BACKGROUND: The aim of this study was to assess the associations between cannabis use and frequency of alcohol intoxication in adolescence with the risk of traumatic brain injury and craniofacial fractures in early adulthood. Hypothesis was that using alcohol and cannabis in adolescence could increase the risk for head traumas. METHODS: Data from the Northern Finland Birth Cohort 1986 (n = 9432 individuals) were used to investigate the prospective association between the self-reported frequency of alcohol intoxication (n = 6472) and cannabis use (n = 6586) in mid-adolescence and register-based, head trauma diagnoses by ages 32-33 years. To test the robustness of these associations, the statistical models were adjusted for a range of other confounders such as illicit drug use, previous head trauma and self-reported mental health problems. RESULTS: In multivariate analyses, cannabis use was statistically significantly associated with a greater risk of traumatic brain injury among females [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.1-3.2, P = 0.024). Frequent alcohol intoxication was a statistically significant independent risk factor for both traumatic brain injury (HR 2.6, 95% CI 1.7-3.9, P < 0.001) and craniofacial fractures (HR 2.7, 95% CI 1.6-4.8, P < 0.001) among males. CONCLUSIONS: Cannabis use in adolescence appears to associate independently with elevated risk for traumatic brain injury among females, and frequent alcohol intoxication in adolescence seems to associate with elevated risk of both traumatic brain injury and craniofacial fractures among males.

Traumatic brain injury related deaths in residents and non-residents of 30 European countries: a cross-sectional study.

The incidence and mortality of traumatic brain injuries (TBI) among non-residents to countries where they occur remains unknown, warranting epidemiological research. Epidemiological data are key to inform prevention and public health policies related to TBI, as well as to help promote safe travelling practice. The aim of this study was to analyse the epidemiological patterns of TBI-related deaths among residents and non-residents in 30 European countries in 2015 using standardised European level data on causes of death. A large-scale cross-sectional study analysing TBI-related deaths in 30 European countries in 2015 among residents and non-residents to the country of occurrence of the death was conducted. Data from death certificates collected on European level by Eurostat were used to calculate the numbers of TBI-related deaths and estimate crude and age-standardised mortality rates. Rates were stratified by country, sex, age-group and by resident status. External causes of the injury were determined using the provided ICD-10 codes. 40,087 TBI-related deaths were identified; overall about 3% occurred among non-residents with highest proportions in Turkey (11%), Luxembourg (9%) and Cyprus (5%). Taking into account tourism intensity in the countries, Bulgaria, Greece and Austria showed highest rates of TBI-related deaths in non-residents: 0.7,0.5 and 0.5 per million overnight stays, respectively. The pooled age-standardised TBI-related mortality in non-residents was 0.2 (95% CI 0.1-0.3), among residents 10.4 (95% CI 9.4-11.5) per 100,000. In non-residents, TBI-related deaths were shifted to younger populations (86% in < 35 years); in non-residents 78% were 15-64 years old. Falls were predominant among residents (47%), and traffic accidents among non-residents (36%). Male:female ratio was higher among non-residents (3.9), compared to residents (2.1). Extrapolating our findings, we estimate that annually 1022 TBI-related deaths would occur to non-residents in the EU-27 + UK and 1488 in Europe as a continent. We conclude, that the primary populations at risk of TBI-related deaths in European countries differ in several characteristics between residents and non-residents to the country of the occurrence of death, which warrants for different approaches in prevention and safety promotion. Our findings suggest that TBI occurring in European countries among non-residents present a problem worthy of attention from public health and travel medicine professionals and should be further studied.

Early versus late tracheostomy for traumatic brain injury: a systematic review and meta-analysis.

INTRODUCTION: Tracheostomy is the most frequent bedside surgical procedure performed on patients with traumatic brain injury who require mechanical ventilation. To compare the effects of early tracheostomy vs. late tracheostomy on the duration of mechanical ventilation in patients with traumatic brain injury, we carried out a systematic review and meta-analysis. EVIDENCE ACQUISITION: MEDLINE, Scopus, Web of Science, and Cochrane were searched from inception to 17th October 2022. Eligible clinical trials and observational studies reporting early versus late tracheostomy in TBI were searched. Two reviewers extracted data and independently assessed the risk of bias. The duration of mechanical ventilation was the primary outcome. EVIDENCE SYNTHESIS: We pooled standardized mean differences and risk differences for random effects model. A total of 368 studies were retrieved and screened. Nineteen studies were selected, including 6253 patients. Mean time for early tracheostomy and late tracheostomy procedures was 6±2.9 days and 17±10.7 days, respectively. Early tracheostomy was associated with shorter mechanical ventilation duration (SMD=-1.79, 95% CI -2.71; -0.88) and fewer ventilator associated pneumonia (RD=-0.11, 95% CI -0.16; -0.06) when compared with late tracheostomy. Moreover, intensive care unit (ICU) (SMD=-1.64, 95% CI -2.44; -0.84) and hospital (SMD=-1.26, 95% CI -1.97; -0.56) length of stay were shorter when compared with late tracheostomy. CONCLUSIONS: The findings from this meta-analysis suggest that early tracheostomy in severe TBI patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient's early rehabilitation and discharge.

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review.

BACKGROUND: The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital. METHODS: We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales. RESULTS: Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores. CONCLUSIONS: This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.

Utility of Person-Environment-Occupation model in exploring sex-specific causes of work-related traumatic brain injury: a retrospective chart review.

BACKGROUND: Work-related traumatic brain injury (wr-TBI) is on the rise. The pre-injury period, a significant consideration for preventive initiatives, is largely unexplored. OBJECTIVES: To identify Person-Environment-Occupation (PEO) variables associated with wr-TBI to inform sex-specific primary prevention. METHODS: Retrospective chart review data were analyses. Two-tailed t-test and chi-squared tests were used to study sex differences. Multivariate logistic regression models of wr-TBI were fit with a priori defined PEO variables. RESULTS: The sample comprised 330 consecutive workers with wr-TBI (40.8 ± 11.1 years old, 71% male). Sex differences were observed across PEO variables. In multivariable logistic regression analyses the odds of sustaining a wr-TBI from a fall increased with the presence of a mood disorder and participation in non-labourer occupations (odds ratio (OR) 2.89 (95% CI 1.06-7.89) and OR 2.89 (95% CI 1.06-7.89), respectively) and decreased being a male (OR 0.31 (95% CI 0.17-0.54)). The odds of sustaining a wr-TBI from being striken by an object was greater in workers with prior head injury (OR 2.8 (95% CI 1.24-6.45)). None of the variables studied were associated with wr-TBI sustained from being striken against an object. CONCLUSIONS: Workers' health status pre-injury is associated with external causes of wr-TBI. Sex differences across PEO categories warrant further study.

Does binge drinking mediate the relationship between four adverse childhood experiences and adult traumatic brain injury? Results from the National Longitudinal Survey of Youth 1979 Cohort.

OBJECTIVE: Adverse childhood experiences (ACEs) are associated with increased risk of sustaining a traumatic brain injury (TBI). Alcohol use may play an important role in this relationship. This study examines whether binge drinking mediates the relationship between four ACEs and TBIs sustained in adulthood. METHODS: Using the National Longitudinal Survey of Youth, 1979 cohort, we conducted longitudinal mediation analyses (n=6317). Interviews occurred annually from 1979 to 1994 and biennially until 2016. We evaluated the direct and indirect effects of individual ACEs (ie, experiencing physical violence, low parental warmth, familial alcoholism and familial mental illness; reported retrospectively) and a cumulative ACEs score on mean level of binge drinking (calculated across waves) and having a TBI in adulthood. To establish temporality, we included binge drinking that was measured at age 18 or older and before any reported TBI. RESULTS: Cumulative ACEs, familial alcoholism and physical abuse exposure were significantly associated with having a TBI through binge drinking, although this only explained a small part of the association between ACEs and TBI. Other ACEs were not significantly associated with binge drinking or TBI. CONCLUSION: The results indicate that while ACEs and adult TBI risk were significantly associated, lifetime binge drinking explains only a small part of the association. Future research could examine alternative social, biological and behavioural mechanisms along the pathway between ACEs and TBI. Determining this mechanism will allow public health practitioners to design and implement effective TBI prevention programmes for those at higher risk of injury due to ACE exposure.

Trends in Neurotrauma Epidemiology, Management, and Outcomes during the COVID-19 Pandemic in Kigali, Rwanda.

National regulations to curb the coronavirus disease 2019 (COVID-19) transmission and health care resource reallocation may have impacted incidence and treatment for neurotrauma, including traumatic brain injury (TBI) and spinal trauma, but these trends have not been characterized in Sub-Saharan Africa. This study analyzes differences in epidemiology, management, and outcomes preceding and during the COVID-19 pandemic for neurotrauma patients in a Rwandan tertiary hospital. The study setting was the Centre Hospitalier Universitaire de Kigali (CHUK), Rwanda's national referral hospital. Adult injury patients presenting to the CHUK Emergency Department (ED) were prospectively enrolled from January 27, 2020 to June 28, 2020. Study personnel collected data on demographics, injury characteristics, serial neurological examinations, treatment, and outcomes. Differences in patients before (January 27, 2020 to March 21, 2020) and during (June 1, 2020 to June 28, 2020) the COVID-19 pandemic were assessed using chi-squared and Mann-Whitney U tests. The study population included 216 patients with neurotrauma (83.8% TBI, 8.3% spine trauma, and 7.9% with both). Mean age was 34.1 years (standard deviation [SD] = 12.5) and 77.8% were male. Patients predominantly experienced injury following a road traffic accident (RTA; 65.7%). Weekly volume for TBI (mean = 16.5 vs. 17.1, p = 0.819) and spine trauma (mean = 2.0 vs. 3.4, p = 0.086) was similar between study periods. During the pandemic, patients had lower Glasgow Coma Scale (GCS) scores (mean = 13.8 vs. 14.3, p = 0.068) and Kampala Trauma Scores (KTS; mean = 14.0 vs. 14.3, p = 0.097) on arrival, denoting higher injury severity, but these differences only approached significance. Patients treated during the pandemic period had higher occurrence of hemorrhage, contusion, or fracture on computed tomography (CT) imaging (47.1% vs. 26.7%, p = 0.003) and neurological decline (18.6% vs. 7.5%, p = 0.016). Hospitalizations also increased significantly during COVID-19 (54.6% vs. 39.9%, p = 0.048). Craniotomy rates doubled during the pandemic period (25.7% vs. 13.7%, p = 0.003), but mortality was unchanged (5.5% vs. 5.7%, p = 0.944). Neurotrauma volume remained unchanged at CHUK during the COVID-19 pandemic, but presenting patients had higher injury acuity and craniotomy rates. These findings may inform care during pandemic conditions in Rwanda and similar settings.

What Happens in TBI? A Wide Talk on Animal Models and Future Perspective.

Traumatic brain injury (TBI) is a global healthcare concern and a leading cause of death. The most common causes of TBI include road accidents, sports injuries, violence in warzones, and falls. TBI induces neuronal cell death independent of age, gender, and genetic background. TBI survivor patients often experience long-term behavioral changes like cognitive and emotional changes. TBI affects social activity, reducing the quality and duration of life. Over the last 40 years, several rodent models have been developed to mimic different clinical outcomes of human TBI for a better understanding of pathophysiology and to check the efficacy of drugs used for TBI. However, promising neuroprotective approaches that have been used preclinically have been found to be less beneficial in clinical trials. So, there is an urgent need to find a suitable animal model for establishing a new therapeutic intervention useful for TBI. In this review, we have demonstrated the etiology of TBI and post- TBI social life alteration, and also discussed various preclinical TBI models of rodents, zebrafish, and drosophila.

Occupation and Risk of Traumatic Brain Injury in the Millennium Cohort Study.

INTRODUCTION: Traumatic brain injury (TBI) is an occupational health hazard of military service. Few studies have examined differences in military occupational categories (MOC) which take into consideration the physical demands and job requirements across occupational groups. METHODS: This study was approved by the University of Texas Health Science Center at Houston Institutional Review Board. Data for this cross-sectional study were obtained from the Naval Health Research Center's Millennium Cohort Study, an ongoing DoD study. Univariate analyses were employed to calculate frequencies and proportions for all variables. Bivariate analyses included unadjusted odds ratios (OR) and 95% CI for the association between all variables and TBI. Multivariable logistic regression was used to calculate adjusted ORs and 95% CIs to assess the association between MOC and TBI, adjusted for potential confounders: sex, race/ethnicity, rank, military status, branch of service, before-service TBI, and panel. Logistic regression models estimated odds of TBI for each MOC, and stratified models estimated odds separately for enlisted and officer MOCs. RESULTS: Approximately 27% of all participants reported experiencing a service-related TBI. All MOCs were statistically significantly associated with increased odds of service-related TBI, with a range of 16 to 45%, except for "Health Care" MOCs (OR: 1.01, 95% CI 0.91-1.13). Service members in "Infantry/Tactical Operations" had the highest odds (OR: 1.45, 95% CI 1.31-1.61) of service-related TBI as compared to "Administration & Executives." Among enlisted service members, approximately 28% reported experiencing a service-related TBI. Among enlisted-specific MOCs, the odds of TBI were elevated for those serving in "Infantry, Gun Crews, Seamanship (OR: 1.79, 95% CI 1.58-2.02)," followed by "Electrical/Mechanical Equipment Repairers (OR: 1.23, 95% CI 1.09-1.38)," "Service & Supply Handlers (OR 1.21, 95% CI 1.08-1.37)," "Other Technical & Allied Specialists (OR 1.21, 95% CI 1.02-1.43)," "Health Care Specialists (OR 1.19, 95% CI 1.04-1.36)," and "Communications & Intelligence (OR: 1.16, 95% CI 1.02-1.31)," compared to "Functional Support & Administration." Among officer service members, approximately 24% reported experiencing a service-related TBI. After adjustment the odds of TBI were found to be significant for those serving as "Health Care Officers" (OR: 0.65, 95% CI: 0.52-0.80) and "Intelligence Officers" (OR: 1.27, 95% CI: 1.01-1.61). CONCLUSIONS: A strength of this analysis is the breakdown of MOC associations with TBI stratified by enlisted and officer ranks, which has been previously unreported. Given the significantly increased odds of service-related TBI reporting within enlisted ranks, further exploration into the location (deployed versus non-deployed) and mechanism (e.g., blast, training, sports, etc.) for these injuries is needed. Understanding injury patterns within these military occupations is necessary to increase TBI identification, treatment, and foremost, prevention.Results highlight the importance of examining specific occupational categories rather than relying on gross categorizations, which do not account for shared knowledge, skills, and abilities within occupations. The quantification of risk among enlisted MOCs suggests a need for further research into the causes of TBI.

Traumatic brain injuries and maxillofacial fractures: a systematic review and meta-analysis.

Traumatic brain injuries (TBIs) associated with maxillofacial fractures (MFFs) are a public health concern worldwide, especially among adult-aged males. There is an urgent need for early detection of associated TBIs in patients with MFFs during the initial assessment and treatment stage to reduce morbidity and mortality. The objective of the present study was to systematically review the literature to determine specific MFF situations associated with TBIs and to identify the factors associated with TBIs in patients with MFFs. The protocol was developed in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020155912. Overall, of 26,774 patients recorded, 13,667 patients (51.04%) sustained MFFs with an associated TBI. The male to female ratio was 4.8:1. RTA was the most common cause. The most common TBIs were concussions, contusions, and closed brain injuries. Within the limits of this study, it was concluded that TBI-related MFFs should be suspected whenever maxillary or mandibular bone fractures occur, especially among adults, males, and people with injuries caused by RTAs and assaults. There is a need to increase the awareness of maxillofacial surgeons on the possible associations of combined maxillofacial trauma and brain injuries.

A systematic review of the timing of intubation in patients with traumatic brain injury: pre-hospital versus in-hospital intubation.

PURPOSE: The objective of this systematic review was to examine current evidence on the risks versus benefit of pre-hospital intubation when compared with in-hospital intubation in adult patients with traumatic brain injuries. METHODS: We conducted electronic searches of PubMed, Medline, Embase, CIANHL and the Cochrane library up to March 2021. Data extracted compared mortality, length of hospital and intensive care stay, pneumonia and functional outcomes in traumatic brain injured patients undergoing pre-hospital intubation versus in-hospital intubation. The risk of bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Ten studies including 25,766 patients were analysed. Seven were retrospective studies, two prospective cohort studies and one randomised control study. The mean mortality rate in patients who underwent pre-hospital intubation was 44.5% and 31.98% for in-hospital intubation. The odds ratio for an effect of pre-hospital intubation on mortality ranged from 0.31 (favouring in-hospital intubation) to 3.99 (favouring pre-hospital). The overall quality of evidence is low; however, the only randomised control study showed an improved functional outcome for pre-hospital intubation at 6 months. CONCLUSIONS: The existing evidence does not support widespread pre-hospital intubation in all traumatic brain injured patients. This does not, however, contradict the need for the intervention when there is severe airway compromise; instead, it must be assessed by experienced personnel if a time critical transfer to hospital is more advantageous. Favourable neurological outcomes highlighted by the randomised control trial favours pre-hospital intubation, but further research is required in this field.

Pediatric traumatic brain injury in a high-income developing country: experience at a level 1 neuro-trauma center.

BACKGROUND: Data on the incidence, prevalence and mortality of pediatric traumatic brain injuries (TBIs) in developing countries are not readily available or do not exist. AIM: The aim of this study was to study the epidemiology of pediatric TBI in developing countries. METHODS: A retrospective study was conducted in a high-volume Neurosurgery Department where we reviewed pediatric cases presenting with TBI between January 2015 and December 2019. Data were collected from the electronic medical records including the patients' demographics, neuro-vital signs, mechanism of TBI and treatment types. Radiological images were screened, and patients were classified according to the type of intracranial hemorrhage. The patient's outcome and Glasgow Coma Scale on discharge were also recorded. RESULT: Nine hundred and eighty-five cases with TBI were admitted over the period of 5 years. The average age was 53.3 months standard deviation (SD) of 39.4. Male gender accounted for 63.7% of the cases. The most common mechanisms of injuries were falls and road traffic accidents/motor vehicle collisions (63.3%, 18.3%), respectively. Nausea and vomiting followed by altered consciousness and drowsiness were the commonest presenting symptoms. Mild TBI accounted for 85.2% of the cases and the majority (92.08%) were treated conservatively (P < 0.005). 93.3% of the cases were categorized as mild head injury upon discharge. The mortality rate was 1.6% in severe TBI cases. CONCLUSION: Children less than 4 years of age were highly affected by TBI. This study gives emergency physicians and neurosurgeons in developing countries an expectation about TBI in pediatric cases and the immediate management to prevent further complications.

Factors influencing the outcomes of patients with severe traumatic brain injury following road traffic crashes.

BACKGROUND: Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity in South Africa. Road traffic crashes (RTCs) are among the commonest aetiology of TBI in South Africa. This study aimed to determine the factors influencing the outcomes in patients with severe TBI following RTCs. METHODS: A retrospective study was conducted of patients who were admitted to the neurosurgery department at Inkosi Albert Luthuli Central Hospital between January 2013 and December 2017 with TBI following RTCs and with a Glasgow Coma Scale (GCS) < 9. Demographic, clinical, and radiological information was obtained. The outcome at discharge was categorised into favourable and unfavourable, using the Glasgow outcome score. Statistical analysis was performed to determine factors contributing to the outcome. RESULTS: The study population consisted of 100 patients. The mean age was 29.5 ± 14.1 years old (range 3-81 years). The majority of patients (85%) were males. Pedestrian vehicle accidents accounted for 46%, compared to motor vehicle collisions (54%). The mean hospital stay duration was 14.2 ± 8.8 days (range 1-43 days). The median postresuscitation GCS was 6 (range 3-8), (p = 0.52). Fifty-two patients had an unfavourable outcome compared to 48 who had a favourable outcome. Eleven patients presented with pupillary abnormalities (p = 0.88), which included unilateral dilated non-reactive (DNR) pupil in seven patients, whilst four patients had bilateral. Five patients developed refractory intracranial hypertension (RIC-HTN), all these patients had unfavourable outcomes, (p = 0.03). Thirty-eight patients developed systemic hypotension (SBP < 90 mmHg), 32 out of these patients had unfavourable outcomes (p < 0.001). In female patients, 80% had unfavourable outcomes compared to 47% of male patients (p = 0.02). Extracranial injuries were diagnosed in 50 patients, and 24 patients had unfavourable outcomes (p = 0.42). CONCLUSION: The outcomes in patients with severe TBI following road traffic crashes are influenced by hypotension (SBP <90 mmHg), RIC-HTN and female gender, which have a negative influence on outcomes.