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dc.contributor.authorLecky, Fiona E
dc.contributor.authorOtesile, Olubukola
dc.contributor.authorMarincowitz, Carl
dc.contributor.authorMajdan, Marek
dc.contributor.authorNieboer, Daan
dc.contributor.authorLingsma, Hester F
dc.contributor.authorMaegele, Marc
dc.contributor.authorCiterio, Giuseppe
dc.contributor.authorStocchetti, Nino
dc.contributor.authorSteyerberg, Ewout W
dc.contributor.authorMenon, David K
dc.contributor.authorMaas, Andrew I R
dc.date.accessioned2021-10-18T08:48:37Z
dc.date.available2021-10-18T08:48:37Z
dc.date.issued2021-09-14
dc.identifier.issn1549-1277
dc.identifier.otherPMC8509890
dc.identifier.other34520460
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/329535
dc.descriptionFunder: Integra LifeSciences
dc.descriptionFunder: OneMind
dc.descriptionFunder: ZNS - Hannelore Kohl Stiftung
dc.description.abstract<h4>Background</h4>Traumatic brain injury (TBI) is an important global public health burden, where those injured by high-energy transfer (e.g., road traffic collisions) are assumed to have more severe injury and are prioritised by emergency medical service trauma triage tools. However recent studies suggest an increasing TBI disease burden in older people injured through low-energy falls. We aimed to assess the prevalence of low-energy falls among patients presenting to hospital with TBI, and to compare their characteristics, care pathways, and outcomes to TBI caused by high-energy trauma.<h4>Methods and findings</h4>We conducted a comparative cohort study utilising the CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) Registry, which recorded patient demographics, injury, care pathway, and acute care outcome data in 56 acute trauma receiving hospitals across 18 countries (17 countries in Europe and Israel). Patients presenting with TBI and indications for computed tomography (CT) brain scan between 2014 to 2018 were purposively sampled. The main study outcomes were (i) the prevalence of low-energy falls causing TBI within the overall cohort and (ii) comparisons of TBI patients injured by low-energy falls to TBI patients injured by high-energy transfer-in terms of demographic and injury characteristics, care pathways, and hospital mortality. In total, 22,782 eligible patients were enrolled, and study outcomes were analysed for 21,681 TBI patients with known injury mechanism; 40% (95% CI 39% to 41%) (8,622/21,681) of patients with TBI were injured by low-energy falls. Compared to 13,059 patients injured by high-energy transfer (HE cohort), the those injured through low-energy falls (LE cohort) were older (LE cohort, median 74 [IQR 56 to 84] years, versus HE cohort, median 42 [IQR 25 to 60] years; p < 0.001), more often female (LE cohort, 50% [95% CI 48% to 51%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001), more frequently taking pre-injury anticoagulants or/and platelet aggregation inhibitors (LE cohort, 44% [95% CI 42% to 45%], versus HE cohort, 13% [95% CI 11% to 14%]; p < 0.001), and less often presenting with moderately or severely impaired conscious level (LE cohort, 7.8% [95% CI 5.6% to 9.8%], versus HE cohort, 10% [95% CI 8.7% to 12%]; p < 0.001), but had similar in-hospital mortality (LE cohort, 6.3% [95% CI 4.2% to 8.3%], versus HE cohort, 7.0% [95% CI 5.3% to 8.6%]; p = 0.83). The CT brain scan traumatic abnormality rate was 3% lower in the LE cohort (LE cohort, 29% [95% CI 27% to 31%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001); individuals in the LE cohort were 50% less likely to receive critical care (LE cohort, 12% [95% CI 9.5% to 13%], versus HE cohort, 24% [95% CI 23% to 26%]; p < 0.001) or emergency interventions (LE cohort, 7.5% [95% CI 5.4% to 9.5%], versus HE cohort, 13% [95% CI 12% to 15%]; p < 0.001) than patients injured by high-energy transfer. The purposive sampling strategy and censorship of patient outcomes beyond hospital discharge are the main study limitations.<h4>Conclusions</h4>We observed that patients sustaining TBI from low-energy falls are an important component of the TBI disease burden and a distinct demographic cohort; further, our findings suggest that energy transfer may not predict intracranial injury or acute care mortality in patients with TBI presenting to hospital. This suggests that factors beyond energy transfer level may be more relevant to prehospital and emergency department TBI triage in older people. A specific focus to improve prevention and care for patients sustaining TBI from low-energy falls is required.
dc.languageeng
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceessn: 1549-1676
dc.sourcenlmid: 101231360
dc.titleThe burden of traumatic brain injury from low-energy falls among patients from 18 countries in the CENTER-TBI Registry: A comparative cohort study.
dc.typeArticle
dc.date.updated2021-10-18T08:48:37Z
prism.issueIdentifier9
prism.publicationNamePLoS medicine
prism.volume18
dc.identifier.doi10.17863/CAM.76983
rioxxterms.versionofrecord10.1371/journal.pmed.1003761
rioxxterms.versionVoR
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
dc.contributor.orcidLecky, Fiona E [0000-0001-6806-0921]
dc.contributor.orcidOtesile, Olubukola [0000-0002-3374-0932]
dc.contributor.orcidMarincowitz, Carl [0000-0003-3043-7564]
dc.contributor.orcidMajdan, Marek [0000-0001-8037-742X]
dc.contributor.orcidNieboer, Daan [0000-0002-4403-6537]
dc.contributor.orcidLingsma, Hester F [0000-0003-2063-9533]
dc.contributor.orcidCiterio, Giuseppe [0000-0002-5374-3161]
dc.contributor.orcidStocchetti, Nino [0000-0003-3250-6834]
dc.contributor.orcidSteyerberg, Ewout W [0000-0002-7787-0122]
dc.contributor.orcidMenon, David K [0000-0002-3228-9692]
dc.contributor.orcidMaas, Andrew I R [0000-0003-1612-1264]
pubs.funder-project-idseventh framework programme (602150)


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International