Incidence and Descriptive Epidemiologic Features of Traumatic Brain Injury in King County, Washington

Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA 98195-7236, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2011; 128(5):946-54. DOI: 10.1542/peds.2010-2259
Source: PubMed


Traumatic brain injury (TBI) is a major cause of disability among US children. Our goal was to obtain population-based data on TBI incidence rates.
We conducted surveillance through a stratified random sample of hospital emergency departments in King County, Washington, to identify children 0 to 17 years of age with medically treated TBIs during an 18-month study period in 2007-2008. Additional cases were identified through hospital admission logs and the medical examiner's office. For a sample of nonfatal cases, parents were interviewed to verify TBIs, and medical record data on severity and mechanisms were obtained.
The estimated incidence of TBIs in this setting was 304 cases per 100,000 child-years. The incidence was highest for preschool-aged children and lowest for children aged 5 to 9 years. Rates were uniformly higher for boys than for girls; there was a larger gender gap at older ages. Falls were the main mechanism of injury, especially among preschool-aged children, whereas being struck by or against an object and motor vehicle-related trauma were important contributors for older children. Approximately 97% of TBI cases were mild, although moderate/severe TBI incidence increased with age.
TBIs led to many emergency department visits involving children, but a large majority of the cases were clinically mild. Incidence rates for King County were well below recent national estimates but within the range reported in previous US studies. Because mechanisms of injury varied greatly according to age, prevention strategies almost certainly must be customized to each age group for greatest impact.

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    • "However, due to the normally low permeability of cerebral blood vessels, it is probable that even a few vessels with altered permeability could significantly contribute to the overall properties of the BBB, and that these changes could explain the short-term changes seen in behavioral tests, in particular in the prepulse inhibition paradigm, that were distinguishable in juvenile animals but not in adult animals. Long-term changes in permeability, as shown by the sucrose permeability test, are correlated in adult rats with altered responses to the dark/light test, suggesting that the impact of inflammation could occur in several phases (short-and longterm ) and that each phase could lead to different behavioral modifications (Stolp et al., 2005, 2011). A third study from the same group analyzes, in a similar model (using the opossum Monodelphis domestica), the ability of minocycline, a potent antiinflammatory molecule, to modulate the inflammation-induced changes in BBB permeability and white matter damage following acute and prolonged inflammation during development. "
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    ABSTRACT: Disorders of the developing brain represent a major health problem. The neurological manifestations of brain lesions can range from severe clinical deficits to more subtle neurological signs or behavioral problems and learning disabilities, which often become evident many years after the initial damage. These long-term sequelae are due at least in part to central nervous system immaturity at the time of the insult. The blood-brain barrier (BBB) protects the brain and maintains homeostasis. BBB alterations are observed during both acute and chronic brain insults. After an insult, excitatory amino acid neurotransmitters are released, causing reactive oxygen species (ROS)-dependent changes in BBB permeability that allow immune cells to enter and stimulate an inflammatory response. The cytokines, chemokines and other molecules released as well as peripheral and local immune cells can activate an inflammatory cascade in the brain, leading to secondary neurodegeneration that can continue for months or even years and finally contribute to post-insult neuronal deficits. The role of the BBB in perinatal disorders is poorly understood. The inflammatory response, which can be either acute (e.g., perinatal stroke, traumatic brain injury) or chronic (e.g., perinatal infectious diseases) actively modulates the pathophysiological processes underlying brain injury. We present an overview of current knowledge about BBB dysfunction in the developing brain during acute and chronic insults, along with clinical and experimental data.
    Frontiers in Neuroscience 02/2015; 9:40. DOI:10.3389/fnins.2015.00040 · 3.66 Impact Factor
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    • "Traumatic Brain Injury (TBI) is the leading cause of mortality and disability among the young population in the developed countries, and its worldwide prevalence is sharply increasing (Feigin et al., 2010; Ghajar, 2000; Maas et al., 2008). TBI affects all ages with highest incidence rates among children, young adults and the elderly (Faul et al., 2010; Hemphill III et al., 2012; Koepsell et al., 2011). TBI is associated with increased incidence of disability and premature death along with heightened medical and socioeconomic burden on individuals, families and societies (Leibson et al., 2011). "
    ISBN-13: 978-1482239829, 1 edited by Wang, Zhang and Kobeissy, 08/2014: chapter 1: pages 17; CRC Press Taylor and Francis Group., ISBN: 978-1482239829
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    • "Epidemiological studies of traumatic brain injury (TBI) clearly demonstrate that compared to any other period of life, the incidence of TBI reaches an apex from childhood through early adulthood,although there is a second spike in TBI incidence after age 65 [7] [27]. Within the first 35 years of life, Thurman et al. [43] have shown that almost twice as many TBIs occur between the ages of 15–24 years than any other time frame, although 0–4 years of age also represents another epoch with high incidence rates of TBI. "
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    ABSTRACT: Brain injury in the pediatric patient not only occurs in an immature brain, but potentially influences all subsequent brain and neurodevelopmental maturation. This presents unique challenges in neuroimaging the developing central nervous system, which is reviewed herein. The most significant neuroimaging advances in assessing pediatric traumatic brain injury (TBI) have occurred with magnetic resonance imaging (MRI), particularly diffusion tensor imaging and the multiple emerging techniques using functional MRI (fMRI). Pediatric neuroimaging findings of TBI are discussed in terms of techniques that can assess underlying neural networks and provide information about neuroplasticity of recovery. Neuroimaging methods also provide insights into the complexities of brain injury, cognitive and neurobehavioral recovery, and how multimodality contemporary neuroimaging methods best demonstrate underlying neuropathology that affects outcome.
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