The epidemiological trends of head injury in the largest Canadian adult trauma center from 1986 to 2007

Clinical article

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Object

This study documents the epidemiology of head injury over the course of 22 years in the largest Level I adult trauma center in Canada. This information defines the current state, changing pattern, and relative distribution of demographic factors in a defined group of trauma patients. It will aid in hypothesis generation to direct etiological research, administrative resource allocation, and preventative strategies.

Methods

Data on all the trauma patients treated at Sunnybrook Health Sciences Centre (SHSC) from 1986 to 2007 were collected in a consecutive, prospective fashion. The authors reviewed these data from the Sunnybrook Trauma Registry Database in a retrospective fashion. The aggregate data on head injury included demographic data, cause of injury, and Injury Severity Score (ISS). The collected data were analyzed using univariate techniques to depict the trend of variables over years. The authors used the length of stay (LOS) and number of deaths per year (case fatality rate) as crude measures of outcome.

Results

A total of 16,678 patients were treated through the Level I trauma center at SHSC from January 1986 to December 2007. Of these, 9315 patients met the inclusion criteria (ISS > 12, head Abbreviated Injury Scale score > 0). The median age of all trauma patients was 36 years, and 69.6% were male. The median ISS of the head-injury patients was 27. The median age of this group of patients increased by 12 years over the study period. Motorized vehicle accidents accounted for the greatest number of head injuries (60.3%) although the relative percentage decreased over the study period. The median transfer time of patients sustaining a head injury was 2.58 hours, and there was an approximately 45 minute improvement over the 22-year study period. The median LOS in our center decreased from 19 to 10 days over the study period. The average case fatality rate was 17.4% over the study period. In multivariate analysis, more severe injuries were associated with increased LOS as was increasing time from injury to hospital presentation. Age and injury severity were independently predictive of mortality.

Conclusions

These data will provide useful information to guide future studies on the changing patterns of head injury, possible mechanisms of injury, and efficient resource allocation for management of this condition.

Abbreviations used in this paper: AIS = Abbreviated Injury Scale; HAIS = head AIS; ISS = Injury Severity Score; LOS = length of stay; SHSC = Sunnybrook Health Sciences Centre.

Article Information

Address correspondence to: Farhad Pirouzmand, M.D., M.Sc., F.R.C.S.C., Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Suite A131, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. email: Farhad.Pirouzmand@sunnybrook.ca.

Please include this information when citing this paper: published online January 28, 2011; DOI: 10.3171/2010.12.JNS10808.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    The median age of patients sustaining head injuries. There was an increase of approximately 12 years of age in the annual median age over the study period from 1986 through 2007.

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    The frequency of head injuries among all trauma patients each year as a function of severity based on HAIS scores: low 1–2, medium 3–4, and high 5–6.

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    The distribution of traumatic events that resulted in head injury (HAIS Score 1–6) for the duration of the study period. These are categorized as recreational events (REC), bicycle accidents (BIC), pedestrian accidents (PED), motor vehicle accidents (MVA), industrial accidents (IND), assault (ASLT), and other (OTH).

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    The relative percentages of mechanisms of injury (as a percentage of total trauma cases sustaining a head injury) for the time periods 1986–1992 and 2000–2007. There has been a relative decrease in the number of head injuries resulting from MVAs and a relative increase in head injuries resulting from recreational events and assaults.

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    The median transfer time from the time of accident to SHSC plotted against the year of presentation.

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    The median ISS for all trauma patients sustaining a head injury (HAIS Score 1–6) plotted against the year of presentation at SHSC.

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    Length of hospital stay for all head-injury patients plotted against year (1986–2007).

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    The case fatality rate for all trauma patients (ISS > 12) sustaining a head injury (HAIS Score 1–6) plotted against year of presentation (1986–2007).

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    The case fatality rate for all trauma patients (ISS > 12) sustaining a mild (HAIS Score 1–2), moderate (HAIS Score 3–4), or severe (HAIS Score 5–6) head injury plotted against the year of presentation (1986–2007).

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