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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    • "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). "

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