Incidence and risk factors of severe traumatic brain injury resulting from road accidents: A population-based study

https://doi.org/10.1016/j.aap.2005.08.001Get rights and content

Abstract

A population-based study was carried out in 1996–2001 to provide the incidence and to identify the risk factors of severe traumatic brain injury (TBI) resulting from a road accident. The severe TBI was defined as an injury to the brain or the skull, excluding scalp injuries, with an abbreviated injury scale (AIS) severity score greater than 2.

The severe TBI of 1238 patients were described. The annual incidence and mortality of severe TBI were, respectively, 13.7 per 100,000 and 5.3 per 100,000. The fatality rate increased from 20% in childhood to 71% over 75-year-old. Compared to restrained car occupants, the odds ratio for having a severe TBI was 18.1 (95% confidence interval, CI = 12.8–25.5) for un-helmeted motorcyclists, 9.2 (95% CI = 7.5–11.3) for pedestrians, 6.4 (95% CI = 4.7–8.8) for un-helmeted cyclists, 3.9 (95% CI = 3.1–4.8) for unrestrained car occupants and 2.8 (95% CI = 2.2–3.5) for helmeted motorcyclists. Even after adjustment for several severity factors, male gender and age above 55 were both risk factors. Prevention programs aiming at improving the head protection should be promoted. The circumstances of the accident should be taken into account to predict a severe TBI.

Introduction

Traumatic brain injury (TBI) is one of the main causes of traumatic mortality and long-term disability, and almost half of all TBI result from road crashes (Andersson et al., 2003, Baldo et al., 2003, Engberg and Teasdale, 2001, Kraus et al., 1984, Servadei et al., 2002, Tiret et al., 1990). Despite this, the only French population-based study about TBI was undertaken in Aquitaine in 1986 (Tiret et al., 1990). Therefore, little is known about the description and the risk factors of severe TBI. Worldwide, most epidemiological studies about TBI were not confined to road accidents but included other mechanisms, e.g. assaults or penetrating injuries, resulting in specific injury patterns. Moreover, significant differences in case ascertainment and inclusion criteria explain the difficulty in study comparison (Bruns and Hauser, 2003). Therefore, more accurate epidemiological data are needed to quantify the real burden of the problem and to implement care and prevention policies. Moreover, such data would be helpful to the medical staff involved in the management of road trauma casualties.

Our objectives were to describe the incidence and the injury patterns, and to identify the risk factors of severe TBI resulting from a road crash.

Section snippets

Data collection

A road trauma registry in the Rhône region of France (population, 1.6 million inhabitants; main city, Lyon) has been in use since January 1995 (Laumon and Martin, 2002). Data collection is based on the participation of all medical units involved in the health care of crash victims in the Rhône region and its close surroundings (201 units): fire emergency services, Emergency Medical Services and follow-up services (intensive care, surgery, and rehabilitation units). To avoid losing “dead at the

Incidences and fatality rate

Over the 6 years, 64,298 injured people were recorded by the registry. Of these, 64,085 had a complete record for age and gender. The overall incidences of minor, moderate and severe TBI per year were 74.7/ per 100,000 population, 47.5 per 100,000 and 13.7 per 100,000, respectively. Cases consisted of 1238 patients who sustained a severe TBI. The percentage of severe TBI was constant for all the study period (1.93%, 95% CI: 1.82, 2.04).

The incidences of severe TBI greatly differed according to

Discussion

This study provides epidemiological data on incidence, mortality and case fatality rate of severe TBI related to a road crash. Comparison with previous epidemiological studies is difficult because there is a lack of a common clear definition of a severe TBI (Bruns and Hauser, 2003). Confusion exists regarding head injury and TBI. Head injury includes external injuries to the face and scalp and may not be associated with TBI. The most widely used clinical TBI severity classification is the

Conclusion

Our study provides incidence and fatality rate of severe TBI resulting from road crash. It suggests that the circumstances of the crash should be taken into account to predict severe TBI. Road safety campaigns promoting the helmet wearing are emphasized by the results of this study. Moreover, specific transport policies targeting elderly people, given their vulnerability, should be promoted.

Acknowledgements

The Rhône road trauma Registry is funded by French Ministries for Research (DSCR), for Transports and for Health (InVS, Inserm).

The authors thank all the staff of the Association du Registre des Victimes d’Accidents de la Circulation (ARVAC), its president Professor V. Banssillon and B. Laumon, in charge of scientific aspects of the Registry, and all those who participated in collecting and recording the data of the Registry: T. Ait Idir, T. Ait Si Selmi, D. Alloatti, M. Andrillat, F. Artru, Y.

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