Multicenter Study Examining Temporal Trends in Traumatic Intracranial Hemorrhage Over Six Years Using Joinpoint Regression.

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0097
Timbre Backen, Kristin Salottolo, David Acuna, Carlos H Palacio, Gina Berg, Andrea Tsoris, Robert Madayag, Kaysie Banton, David Bar-Or
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引用次数: 0

Abstract

The aging US population has altered the epidemiology of traumatic injury, but there are few studies examining changing patterns of traumatic intracranial hemorrhage (tICH). We examined temporal changes in incidence, demographics, severity, management, and outcomes of tICH among trauma admissions at six US Level I trauma centers over 6 years (July 1, 2016-June 30, 2022). Patients with tICH (subdural, epidural, subarachnoid, and intracerebral hemorrhage) were identified by 10th revision of the International Statistical Classification of Diseases diagnosis codes. Temporal trends were examined over 12 six-month intervals using joinpoint regression and reported as biannual percent change (BPC); models without joinpoints are described as linear trends over time. There were 67,514 trauma admissions over 6 years and 11,935 (17.7%) patients had a tICH. The proportion of tICH injuries significantly increased 2.6% biannually from July 2016 to July 2019 (BPC = 2.6, p = 0.04), then leveled off through June 2022 (BPC = -0.9, p = 0.19). Similarly, the proportion of geriatric patients (≥65 years old) increased 2.4% biannually from July 2016 to July 2019 (BPC = 2.4, p = 0.001) as did injuries due to falls (BPC = 2.2, p = 0.01). Three of the four most prevalent comorbidities significantly increased: hypertension linearly increased 2.1% biannually, functional dependence increased 25.5% biannually through June 2019, and chronic anticoagulant use increased 19.0% biannually through June 2019 and then 3.1% thereafter. There were no trends in the rates of neurosurgical intervention (BPC = -0.89, p = 0.40), ED Glasgow coma score 3-8 (BPC = -0.4, p = 0.77), or presence of severe extracranial injuries (BPC = -0.7, p = 0.45). In-hospital mortality linearly declined 2.6% biannually (BPC = 2.6, p = 0.05); however, there was a 10.3% biannual linear increase in discharge to hospice care (BPC = 10.3, p < 0.001). These results demonstrate the incidence of tICH admissions is temporally increasing, and the population is growing older with more comorbidities and injuries from falls. Yet, traumatic brain injury severity and neurosurgical management are unchanged. The shift from in-patient death to hospice care suggests an increased need for palliative care services.

多中心研究:利用连接点回归分析六年来创伤性颅内出血的时间趋势
美国人口老龄化改变了创伤流行病学,但很少有研究探讨创伤性颅内出血(tICH)的变化模式。我们研究了美国六家一级创伤中心 6 年来(2016 年 7 月 1 日至 2022 年 6 月 30 日)创伤住院患者中 tICH 的发病率、人口统计学、严重程度、管理和预后的时间变化。tICH(硬脑膜下出血、硬脑膜外出血、蛛网膜下腔出血和脑内出血)患者根据第十版《国际疾病统计分类》诊断代码确定。使用连接点回归法检查了 12 个 6 个月时间间隔内的时间趋势,并以半年变化百分比 (BPC) 的形式进行报告;没有连接点的模型被描述为随时间变化的线性趋势。6 年间共有 67,514 例创伤入院,11,935 例(17.7%)患者发生了 tICH。从 2016 年 7 月到 2019 年 7 月,tICH 损伤的比例每两年显著增加 2.6%(BPC = 2.6,p = 0.04),然后到 2022 年 6 月趋于平稳(BPC = -0.9,p = 0.19)。同样,老年患者(≥65 岁)的比例从 2016 年 7 月到 2019 年 7 月每两年增加 2.4%(BPC = 2.4,p = 0.001),跌倒导致的伤害也是如此(BPC = 2.2,p = 0.01)。四种最普遍的合并症中有三种显著增加:高血压每半年线性增加 2.1%,功能依赖到 2019 年 6 月每半年增加 25.5%,慢性抗凝剂使用到 2019 年 6 月每半年增加 19.0%,此后增加 3.1%。神经外科干预率(BPC = -0.89,p = 0.40)、ED 格拉斯哥昏迷评分 3-8 分(BPC = -0.4,p = 0.77)或存在严重颅外损伤(BPC = -0.7,p = 0.45)均无趋势。院内死亡率每半年线性下降 2.6%(BPC = 2.6,P = 0.05);然而,出院后接受临终关怀的死亡率每半年线性上升 10.3%(BPC = 10.3,P < 0.001)。这些结果表明 TICH 的入院率在时间上不断增加,而且人口年龄越来越大,合并症和跌倒造成的伤害也越来越多。然而,创伤性脑损伤的严重程度和神经外科治疗方法却没有改变。从住院死亡到临终关怀的转变表明对姑息治疗服务的需求在增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
2.40
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