Background: Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children.Hypothesis: We hypothese that due to adequate treatment of EDH in children and adolescence excellent clinical and functional outcome can be reached.Purpose: To evaluate retrospectively our treatment process of EDH and to elucidate the relationship between trauma mechanism, injury pattern, radiological presentation, subsequent therapy and functional outcome.Patients and methods: Hundred and twenty infants and children with traumatic brain injuries (TBI) were treated between 1992 and 2009 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow Outcome Scale (GOS) scores at hospital discharge and at follow-up visits were used. EDH was classified according to the Rotterdam score.Results: Finally, 41 cases were diagnosed with an EDH and therefore included in our study. Twenty-one cases were treated surgically; however of these in 11 patients delayed surgery was necessary. Twenty patients were treated conservatively. Two patients (5%) died within 24 hours, 39 patients (95%) survived. One of the operatively treated patients (2%) presented in a vegetative state, another one had severe disability, and however, 32 patients (78%) showed good recovery at latest follow-up.Discussion: Age, severity of TBI, and neurological status were the main factors influencing outcome after TBI due to acute EDH. We found that immediate as well as delayed surgical evacuation of EDH resulted in excellent outcomes in most cases. Conservative treatment was started in 76% of our cases - however needing in 35% delayed surgical intervention. Overall in all groups excellent final clinical and neurological outcomes could be reached. (C) 2016 Elsevier Masson SAS. All rights reserved.

Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. We hypothese that due to adequate treatment of EDH in children and adolescence excellent clinical and functional outcome can be reached. To evaluate retrospectively our treatment process of EDH and to elucidate the relationship between trauma mechanism, injury pattern, radiological presentation, subsequent therapy and functional outcome. A total of 120 infants and children with traumatic brain injuries (TBI) were treated between 1992 and 2009 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow Outcome Scale (GOS) scores at hospital discharge and at follow-up visits were used. EDH was classified according to the Rotterdam score. Finally, 41 cases were diagnosed with an EDH and therefore included in our study. Twenty-one cases were treated surgically; however of these in 11 patients delayed surgery was necessary. Twenty patients were treated conservatively. Two patients (5%) died within 24 hours, 39 patients (95%) survived. One of the operatively treated patients (2%) presented in a vegetative state, another one had severe disability, and however, 32 patients (78%) showed good recovery at latest follow-up. Age, severity of TBI, and neurological status were the main factors influencing outcome after TBI due to acute EDH. We found that immediate as well as delayed surgical evacuation of EDH resulted in excellent outcomes in most cases. Conservative treatment was started in 76% of our cases – however needing in 35% delayed surgical intervention. Overall in all groups excellent final clinical and neurological outcomes could be reached.

Data regarding the impact and timing of tracheostomy in patients with isolated traumatic brain injury (TBI) are ambiguous. Our goal was to evaluate the impact of tracheostomy on hospital mortality in patients with moderate or severe isolated TBI.

Purpose The aim of this study was to analyse the epidemiological patterns (mortality, incidence of non-fatal cases and overall incidence), of traumatic spinal cord injuries (TSCI) in 2002–2012 in Austria. Methods TSCI-related deaths and hospital admissions in Austria 2002–2012 were obtained from Statistics Austria and analysed. Mortality rates, as well as non-fatal and overall incidence rates were calculated and compared across the age spectrum and by sex. Additionally, the main causes and demographic characteristics of victims were analysed. Results The crude overall incidence rate of TSCI was 16.96, CI 95 % 16.95–16.97 and the standardized incidence rate was 13.98, CI 95 % 13.97–13.99 per million (annual average rate). An annual increase in fatality rates was observed occurring mostly in the age group[65 years (Kendall’s Tau = 0.1). Falls (mortality rate 19.58, CI 95 % 19.57–19.59) and injuries at home (incidence rate 56.57, CI 95 % 56.56–56.58) were the principal causes of fatal and non-fatal TSCI, respectively. Injuries to the neck region were the most common. All indicators were the highest for the age group[65 years: non-fatal incidence rate 23.55, CI 95 % 23.54–23.56; mortality rate 21.4, CI 95 % 21.39–21.41; and overall incidence rate 47.9, CI 95 % 47.89–47.91. A clear male dominance was observed (incidence rate ratio 1.9, CI 95 % 1.4–2.7). Conclusion The population[65 years has been at the highest risk of TSCI in Austria for the analysed period and therefore preventive activities should be focused on this group. The increasing overall incidence of TSCI was driven by the increasing mortality rates that were highest in the age group[65 years. We advocate harmonization of epidemiological reporting especially regarding aetiology of TSCI in order to better inform policy makers and prevention.

Objectives: Falls are among the major external causes of unintentional injury and injury-related mortality in the elderly. The aim of this study was to compare the patterns of unintentional fall-related mortalities in two countries with different demographic structure: Slovakia and Austria in 2003-2010.Methods: A study was conducted using death certificate data, trends of fall-related mortality in the elderly (over 65 years) in Austria and Slovakia were compared. Crude and age-standardised mortality rates were calculated. Rate ratios were used to quantify differences based on age, sex and country. The role of demographic structure and population ageing was considered.Results: The annual average crude mortality for Slovakia was 28.82, for Austria 54.19 per 100 000 person-years. Increasing rates were observed towards higher age in both countries. Males had higher mortality than females (1.18 times higher in Austria, 2.4 higher in Slovakia). In ages over 75 years rates were significantly higher in Austria, compared to Slovakia. Injuries to head (in males) and hip (in females) were most commonly the underlying cause of death. The proportion of populations over 65 and over 80 and rate of their increase were higher in Austria than in Slovakia.Conclusions: We conclude that higher proportions of the elderly population of Austria could have contributed to the higher fall-related mortality rates compared to Slovakia, especially in females over 80 years. Our study quantified the differences between two countries with different structure of the elderly population and these findings could be used in planning future needs of health and social services and to plan prevention in countries where a rapid increase in age of the population can be foreseen.

AIM:Traumatic brain injuries (TBI) are a major public health problem. Although they are well studied, information on some aspects, such as the place of occurrence, is limited. The aim of this study was to describe the patterns of severity, causes and outcomes of TBI occurring at different locations and to identify the primary populations at risk of suffering TBI at each of the analysed locations.METHODS:1,818 patients with TBI admitted to hospitals in Austria, Slovakia, Croatia, Bosnia, and Macedonia were analysed. Primary populations at risk, injury severity and extent along with short/long-term outcomes were analysed for TBI at each location.RESULTS:The highest mean age (57.9 years, p<0.001) was observed in injuries at home. The distribution of injury causes across the group was significantly different (p<0.001), with falls (39%) and traffic accidents (30%) being predominant. TBI occurring on roads or highways were the most severe (mean ISS=32.5, p<0.001; mean GCS=7.8, p<0.001). Injuries at home had the worst outcome (50% mortality, p<0.001 and 70% unfavourable outcome, p<0.001) whereas TBI at sport facilities or outdoors had the best outcome (24% mortality, 44% unfavourable outcome). When adjusted for age and severity, TBI occurring at home had the highest odds of mortality (OR=3.12, 95% CI=1.86-5.25) and unfavourable outcome (OR=2.51, 95% CI=1.54-4.08), compared to sports facility and outdoors as a reference.CONCLUSIONS:TBI at different locations display distinctive patterns as to causes, severity, outcome and populations at risk. Location is therefore a relevant epidemiological aspect of TBI and we advocate its inclusion in future studies. Definitions of primary populations at risk at different locations could help in targeted public health actions.

PURPOSE:Low level falls are a common cause of traumatic brain injuries (TBI) and are associated with significant mortality and disability. The aim of this study was to analyse whether BMI, height and weight of patients were related to severity, patterns and outcomes of TBI caused by low level falls.METHODS:Data on patients with TBI where cause of injury was a low level fall (fall < 3 m) with known body mass index (BMI) (N = 683) were analysed. Patients were categorized into underweight, normal, pre-obese and obese based on BMI and demographic characteristics, injury severity, patterns and outcomes were compared. In addition, physiological status, comorbidities and length of hospitalization were analysed in a subset of patients where this information was available.RESULTS:The median BMI was 25.6. About 1/10 of patients were obese. The mean age and proportion of male sex of patients was increasing with increasing BMI. The patients in all BMI groups were of similar injury severity and neurological status. There was also no difference in mortality and functional outcome based on patient's BMI. Obese and pre-obese patients required longer stay at ICU and in hospital.CONCLUSION:We found no associations between BMI and severity or outcome of TBI caused by low level falls. More detailed data and further studies are needed to fully elucidate these complex relationships.

BACKGROUND:Existing evidence concerning the management of traumatic brain injury (TBI) patients underlines the importance of appropriate treatment strategies in both prehospital and early in-hospital care. The objectives of this study were to analyze the current state of early TBI care in Austria with its physician-based emergency medical service. Subsequently, identified areas for improvement were transformed into treatment recommendations. The proposed changes were implemented in participating emergency medical services and hospitals and evaluated for their effect. METHODS:14 Austrian centers treating TBI patients participated in the study. Between 2009 and 2012 all patients with Glasgow Coma Scale score < 13 and/or AIS head > 2 within 48 h after the accident, were enrolled. Data were collected in 2 phases: in the first phase data of 408 patients were analyzed. Based on this, a set of recommendations expected to improve outcomes was developed by the study group and implemented in participating centers. Recommendations included time factors (transport to appropriate trauma center, avoiding secondary transfer), adequate treatment strategies (prehospital fluid and airway management, anesthesia, ventilation), monitoring (pulse oximetry and blood pressure monitoring in all patients, capnography in ventilated patients) for prehospital treatment. In the emergency department focus was on first CT scan as soon as possible, short interval between CT scan and surgery and early use of thrombelastometry to optimize coagulation. Following implementation of these recommendations, data on 325 patients were collected and analyzed in phase 2. Final analysis investigated the impact of the recommendations on patient outcomes. RESULTS:Patients in both data collection phases showed comparable demographic and injury severity characteristics. Treatment changes, especially in terms of fluid management, monitoring and normoventilation as well as thrombelastometry measurements were implemented successfully in phase 2, and led to significant improvement of patient outcomes. Hospital mortality was reduced from 31 % to 23 %. We found a lower rate of unfavorable outcomes, a significant increase in unexpected survivors and more patients with unexpected favorable outcomes as well. CONCLUSIONS:The results of this study clearly demonstrate that the outcomes of TBI patients can be improved with appropriate early care.

BACKGROUND traumatic brain injury (TBI) is a significant public health problem. Developed countries report a significant increase of TBI in older adults in the past decades. The objective of this study was to investigate the changes in TBI-related mortality in older Austrians (65 years or older) between 1980 and 2012 (33 years) and to identify possible causes for these changes. METHODS data from Statistics Austria on mortality in Austria between 1980 and 2012 were screened and data on TBI-related mortality in adults aged 65 and older were extracted and analysed, based on the diagnostic codes of the International Classification of Diseases, 10th and 9th revision. Mortality rates were calculated for 5-year age groups; standardized mortality rates were calculated for the total. Mechanism of injury was analysed for all events, both sexes and individual age groups. RESULTS between 1980 and 2012, 16,204 people aged 65 or older died from TBI in Austria; 61% of these were male. Fatal TBI cases and mortality rates increased in the oldest age groups (80 years or older). Half of the fatal TBI cases were caused by falls, 22% by traffic accidents and 17% by suicides. Rate of fall-related fatal TBI increased and rate of traffic accident-related fatal TBI decreased with age. CONCLUSION preventive measures introduced in the past decades in the developed countries have contributed to a decrease in traffic injuries. However, falls in the older population are on the rise, mainly due to ageing of the population, throughout the reported period. It is important to take preventive measures to stop the epidemics of fall-related TBIs and fatalities in older adults.

Background: To investigate changes in TBI mortality in Austria during 1980-2012 and to identify causes for these changes.Methods: Statistik Austria provided data (from death certificates) on all TBI deaths from January 1980-December 2012. Data included year/month of death, age, sex, residency of the cases and mechanism of accident. Data regarding the size of the age groups was obtained from Statistik Austria. Mortality rates (MR; deaths/10(5) population/year) were calculated for male vs. female patients and for different age groups. Changes in mechanisms of TBI were evaluated.Results: The MR decreased from 28.1 to 11.8 deaths/10(5) population/year. Traffic-related TBI deaths decreased from 62% to 9%. This caused a significant decrease in TBI deaths in younger age groups. Fall-related TBI deaths (mostly geriatric cases) remained unchanged. Falls became the leading cause; its rate increased from 22% to 64% of all TBI deaths. Thus, the mean age of fatal TBI cases increased by 20 years and the rate of cases aged <60 years decreased from 71% to 28%. Another important cause was suicide by firearms; its rate increased from 10% to 23% of all TBI deaths.Conclusions: These findings warrant better prevention of falls in the elderly and of suicides.

BACKGROUND:The goal of this paper was to investigate the association between patterns of intracranial hypertension (IH) and outcomes, to describe the treatment of patients with different patterns of IH, and to examine whether IH is an independent predictor of mortality and unfavourable outcome, respectively.METHODS:A retrospective analysis of data collected prospectively in 9 central European centers is presented. 204 patients with severe TBI who had intracranial pressure (ICP) monitoring were coded as having either early (within first 2 days), late (after first 2 days), or no IH. IH was defined as >60 min of ICP >20 mmHg/day. The total number of hours/day of IH was recorded. Treatment was followed closely for the first 10 days using the therapy intensity level (TIL) score. Associations between types of IH and demographic factors, trauma severity, or treatment factors as well as outcomes were analysed.RESULTS:Patients in the early IH group were the most severely injured. They had the highest TIL levels, had the highest mortality (48%) and the highest rate of unfavourable outcome (65%) followed by the late IH group (20% and 57%) and the no IH group (23% and 36%). Duration of IH correlated significantly with hospital mortality. IH was an independent predictor of mortality and unfavourable outcome after adjusting for age, Glasgow Coma Scale score, and Abbreviated Injury Score "head".CONCLUSION:Intracranial hypertension with early onset is independently associated with significantly worse outcome in patients with severe TBI. The total duration of IH shows a significant correlation to mortality.

Background: The goal was to compare epidemiology of hospital admissions for traumatic brain injury (TBI) in Austrian residents vs. visitors to Austria.Methods: Data on all hospital admissions due to TBI (ICD-10 codes S06.0-S06.9; years 2009-2011) was provided by the Austrian Statistical Office. Data on Austrian population and on tourism (visitor numbers, nights spent) was retrieved from www.statistik.at. Age, sex, mechanism of injury, season and mortality was analysed for Austrian residents vs. visitors.Results: Visitors contributed 3.9% to the total population and 9.2% of all TBI cases. Incidence of hospital admissions was 292/100000/year in Austrian residents and was 727/100000/year in visitors. Male: female ratio was 1.39:1 in Austrian residents and 1.55:1 in visitors. Austrian cases were older than visitors' cases (mean age 41 vs. 28 years). Austrian cases were distributed evenly over the seasons, while 75% of the visitors' cases happened during winter and spring. The most frequently observed causes of TBI in Austrian residents were private accidents, while sports caused almost half of the visitors' cases. Hospital mortality was lower in visitors than in Austrian residents (0.8 vs. 2.1%).Conclusion: Sports-related TBI of visitors causes a significant workload for Austrian hospitals. Better prevention is warranted.

Traumatic brain injuries (TBIs) are of special concern in the pediatric and adolescent population because of high incidence, mortality, and potential years of life lost (PYLL). Knowledge on causes and mortality trends is essential for effective prevention. The aim of this study was to analyze the long-term trends and causes of TBI-related mortality between 1980 and 2012 in the pediatric and adolescent populations of Austria. Death certificate data on TBI-related deaths of children and adolescents 0-19 years of age and exact population numbers were obtained from the Austrian Statistical Office. Five age groups were created. Mortality trends and causes of TBI were analyzed. PYLL were used to indicate the public health impact. Of 5319 identified TBI-related deaths, 75% were male victims. The annual mortality rates per 100,000 between 1980 and 2012 decreased from 25 to 2.6 in males, from 8.5 to 1.0 in females, and from 16.9 to 1.8 in the total population. Those 15-19 years of age had the highest mortalities, followed by 0-2 years of age. Over 80% of deaths were caused by accidents, inflicted TBIs were most common in those 0-2 years of age, and traffic accidents in those 15-19 years of age. In the studied period, 295,793 PYLL could be attributed to TBIs. Measures to prevent traffic accidents contributed significantly to the decrease of mortality and PYLL, especially in 15- to 19-year-old men. Causes and trends of TBI-related mortality exhibit age-group-specific patterns, and this knowledge could contribute to planning further preventive action to reduce TBI fatalities in the studied population.

The goal of this study was to compare outcomes of patients with severe traumatic brain injury (TBI) who had been admitted either during workdays from 7 a.m. to 7 p.m. (“regular service”) or during any other time (“on-call service”).