Toril Skandsen - Academia.edu (original) (raw)

Papers by Toril Skandsen

Journal of neurosurgery, Apr 1, 2022

OBJECTIVE The primary aim of this study was to evaluate the global outcome longitudinally over 5 ... more OBJECTIVE The primary aim of this study was to evaluate the global outcome longitudinally over 5 years in children and adolescents surviving moderate to severe traumatic brain injury (msTBI) to investigate changes in outcome over time. The secondary aim was to explore how age at the time of injury affected outcome. METHODS All children and adolescents (aged 0–17 years; subdivided into children aged 0–10 years and adolescents aged 11–17 years) with moderate (Glasgow Coma Scale [GCS] score 9–13) or severe (GCS score ≤ 8) TBI who were admitted to a level I trauma center in Norway over a 10-year period (2004–2014) were prospectively included. In addition, young adults (aged 18–24 years) with msTBI were included for comparison. Outcome was assessed with the Glasgow Outcome Scale–Extended (GOS-E) at 6 months, 12 months, and 5 years after injury. The effect of time since injury and age at injury on the probability of good outcome was estimated by the method of generalized estimating equations. RESULTS A total of 30 children, 39 adolescents, and 97 young adults were included, among which 24 children, 38 adolescents, and 76 young adults survived and were planned for follow-up. In-hospital mortality from TBI was 7% for children, 3% for adolescents, and 18% for young adults. In surviving patients at the 5-year follow-up, good recovery (GOS-E score 7 or 8) was observed in 87% of children and all adolescents with moderate TBI, as well as in 44% of children and 59% of adolescents with severe TBI. No patient remained in a persistent vegetative state. For all patients, the odds for good recovery increased from 6 to 12 months (OR 1.79, 95% CI 1.15–2.80; p = 0.010), although not from 12 months to 5 years (OR 0.98, 95% CI 0.62–1.55; p = 0.940). Children/adolescents (aged 0–17 years) had higher odds for good recovery than young adults (OR 2.86, 95% CI 1.26–6.48; p = 0.012). CONCLUSIONS In this population-based study of pediatric msTBI, surprisingly high rates of good recovery over 5 years were found, including good recovery for a large majority of children and all adolescents with moderate TBI. Less than half of the children and more than half of the adolescents with severe TBI had good outcomes. The odds for good recovery increased from 6 to 12 months and were higher in children/adolescents (aged 0–17 years) than in young adults.

Journal of Neurotrauma, Apr 1, 2018

The aim of this study was to investigate how traumatic axonal injury (TAI) lesions in the thalamu... more The aim of this study was to investigate how traumatic axonal injury (TAI) lesions in the thalamus, basal ganglia, and brainstem on clinical brain magnetic resonance imaging (MRI) are associated with level of consciousness in the acute phase in patients with moderate to severe traumatic brain injury (TBI). There were 158 patients with moderate to severe TBI (7-70 years) with early 1.5T MRI (median 7 days, range 0-35) without mass lesion included prospectively. Glasgow Coma Scale (GCS) scores were registered before intubation or at admission. The TAI lesions were identified in T2*gradient echo, fluid attenuated inversion recovery, and diffusion weighted imaging scans. In addition to registering TAI lesions in hemispheric white matter and the corpus callosum, TAI lesions in the thalamus, basal ganglia, and brainstem were classified as uni-or bilateral. Twenty percent of patients had TAI lesions in the thalamus (7% bilateral), 18% in basal ganglia (2% bilateral), and 29% in the brainstem (9% bilateral). One of 26 bilateral lesions in the thalamus or brainstem was found on computed tomography. The GCS scores were lower in patients with bilateral lesions in the thalamus (median four) and brainstem (median five) than in those with corresponding unilateral lesions (median six and eight, p = 0.002 and 0.022). The TAI locations most associated with low GCS scores in univariable ordinal regression analyses were bilateral TAI lesions in the thalamus (odds ratio [OR] 35.8; confidence interval [CI: 10.5-121.8], p < 0.001), followed by bilateral lesions in basal ganglia (OR 13.1 [CI: 2.0-88.2], p = 0.008) and bilateral lesions in the brainstem (OR 11.4 [CI: 4.0-32.2], p < 0.001). This Trondheim TBI study showed that patients with bilateral TAI lesions in the thalamus, basal ganglia, or brainstem had particularly low consciousness at admission. We suggest these bilateral lesions should be evaluated further as possible biomarkers in a new TAI-MRI classification as a worst grade, because they could explain low consciousness in patients without mass lesions.

Journal of Neurosurgery, Oct 1, 2020

ABBREVIATIONS AIC = Akaike information criterion; AUC = area under the ROC curve; DWI = diffusion... more ABBREVIATIONS AIC = Akaike information criterion; AUC = area under the ROC curve; DWI = diffusion-weighted imaging; GCS = Glasgow Coma Scale; GRE = gradient echo; ICC = intraclass correlation coefficient; PTA = posttraumatic amnesia; ROC = receiver operating characteristic; SWI = susceptibility-weighted imaging; TAI = traumatic axonal injury; TBI = traumatic brain injury.

Acta Anaesthesiologica Scandinavica, Oct 24, 2012

Background: Traumatic brain injury (TBI) treatment protocols have been introduced in the intensiv... more Background: Traumatic brain injury (TBI) treatment protocols have been introduced in the intensive care unit (ICU) to avoid secondary brain injury. In this study, we aimed to evaluate the deviations from such a treatment protocol and the frequency of extracranial complications, and relate these findings to outcome. Methods: During a 5-year period (2004-2009), 133 patients with severe TBI [Glasgow Coma Scale (GCS) score Յ 8] were prospectively included. The following deviations from treatment goals were studied: intracranial pressure (ICP), blood pressure, haemoglobin, blood glucose, serum sodium, serum albumin, body temperature and extracranial complications during the ICU stay. Outcome was assessed using Glasgow Outcome Scale Extended score at 12 months. Results: The frequencies of deviations from the treatment goals were: episodes of intracranial hypertension 69.5% (of monitored patients), hypotension 20.3%, anaemia 77.4%, hyperglycaemia 42.9%, hyponatremia 34.6%, hypoalbuminemia 30.8% and hyperthermia 54.9%. Pulmonary complications were common (pneumonia 72.2%, acute respiratory distress syndrome/acute lung injury 31.6%). Thrombocytopenia (4.5%), severe sepsis (3.0%), renal failure (0.8%) and liver failure (0.8%) were infrequent. Twenty-six (19.5%) patients died within the first 12 months due to the head injury. Age, GCS score, pupil dilation, Injury Severity Score (ISS), ICP > 25 mmHg, hyperglycaemia and pneumonia predicted a worse outcome. Conclusions: Deviations from the TBI treatment protocol were frequent. Pneumonia was the most frequent extracranial complication. Age, GCS score, pupil dilation, ISS, high ICP, hyperglycaemia and pneumonia predicted a worse outcome.

Journal of Head Trauma Rehabilitation, Mar 1, 2015

Objectives: To determine the rates of cognitive impairment 1 year after severe traumatic brain in... more Objectives: To determine the rates of cognitive impairment 1 year after severe traumatic brain injury (TBI) and to examine the influence of demographic, injury severity, rehabilitation and sub-acute functional outcomes on cognitive outcomes 1 year after severe TBI. Setting: National multicenter cohort study over 2 years. Participants: Patients (N=105) aged ≥16 years with Glasgow Coma Scale (GCS) 3-8 and Galveston Orientation and Amnesia Test >75. Main Measures: Neuropsychological tests representing cognitive domains of Executive Functions, Processing Speed, and Memory. Injury severity included Rotterdam CT score, GCS, and post-traumatic amnesia (PTA), together with length of rehabilitation and Glasgow Outcome Scale-Extended (GOSE). Results: Totally, 67% of patients with severe TBI had cognitive impairment. Executive Functions, Processing Speed, and Memory were impaired in 41%, 58%, and 57% of patients, respectively. Using multiple regression, Processing Speed was significantly related to PTA, GOSE, and length of inpatient rehabilitation (R 2 =.30); Memory was significantly related to GOSE (R 2 =.15); and Executive functions to PTA (R 2 =.10). Rotterdam CT and GCS scores were not associated with cognitive functioning at one year post-injury. Conclusion: Findings highlight cognitive consequences of severe TBI with nearly two-thirds of patients showing cognitive impairments in at least one of three cognitive domains. Regarding injury severity predictors, only PTA was related to cognitive functioning.

Journal of Head Trauma Rehabilitation, Sep 1, 2010

To examine congruence between participant (P) and significant other (SO) reports on societal part... more To examine congruence between participant (P) and significant other (SO) reports on societal participation in 3 objective domains (economic, community, and social activities) and subjective satisfaction with participation at 1 year after traumatic brain injury (TBI). Participants: Ninety-seven persons with moderate to severe TBI and their SOs (27 spouses/partners, 47 parents, 23 other relatives/friends). Main outcome measure: Community Participation Indicators questionnaire, divided into Objective (Economic, Community, Social) and Subjective (Satisfaction) subscales. Design: Prospective correlational study. Results: P-SO congruence differed by domain of participation, with Economic and Community indicators showing higher agreement than Social and Satisfaction items. Congruence was not affected by P-SO relationship or whether the pair lived together. However, pairs who spent at least daily time together had significantly higher agreement on Satisfaction items than pairs who were together less often. Congruence was not predicted by SOs' self-reported degree of awareness of Ps' concerns. Severity of TBI, within the range represented in this sample, had no effect on P-SO congruence in any domain. Conclusion: In research on participation after TBI, proxy report may be an acceptable substitute for missing participant report on productivity and community activity outcomes. However, proxy responses should be used with caution for questions about social activities and degree of satisfaction with participation.

Tidsskrift for Den Norske Laegeforening, Nov 16, 2006

Background: Head trauma of varying severity may induce diffuse axonal injury. More attention is n... more Background: Head trauma of varying severity may induce diffuse axonal injury. More attention is now given to this important type of injury, as examinations of head-injured patients with MRI have given us more knowledge. Material and methods: We present a review of diffuse axonal injury with the main focus on clinical presentation and radiology, based on a Pubmed search and own experience. Results and interpretation: Axons seldom rupture at the moment of injury. It is more common that it takes hours or a few days until the axons are detached. Areas most commonly affected are white matter in the hemispheres, corpus callosum and the brain stem. Half of the patients with severe head injury have diffuse axonal injury, but this type of injury also occurs in patients with moderate and mild head injury. The clinical presentation and prognosis will therefore vary. Diffuse axonal injury can present with typical signs revealed by CT, but the CT scan may also be normal, especially when there is no bleeding. New MRI techniques are more sensitive and show that diffuse axonal injury occurs more often than previously assumed. MRI is therefore necessary to give the patients correct diagnoses and adequate rehabilitation and follow-up.

Acta Anaesthesiologica Scandinavica, Aug 15, 2007

Background: In patients with severe head injury, control of physiological variables is important ... more Background: In patients with severe head injury, control of physiological variables is important to avoid intracranial hypertension and secondary injury to the brain. The aims of this retrospective study were to evaluate deviations of physiological variables and the incidence of extracranial complications in patients with severe head injury. We also studied if these deviations could be related to outcome. Patients and methods: One hundred and thirty-three patients were included during a 5-year period (1998-2002). Deviations from treatment goals for the following physiological variables were studied: blood pressure, haemoglobin, blood sugar, serum sodium, serum albumin and temperature. Extra cerebral organ complications were also recorded as well as outcome at 6 months. Results: The median age was 32 years (range; 1-88 years). Median Glasgow Coma Scale (GCS) before intubation was 6 (range; 3-14). The frequencies of severe deviations from the desired values of the physiological variables for at least one treatment day were: hypotensive episodes (systolic BP < 90 mmHg)-20%, anaemia (hgb < 8 g/dL)-22%, blood glucose >10 mmol/l-26%, serum sodium concentration <130 mmol/ l-10%, serum albumin <25 g/l À1-31% and hyperthermia >39 8C-24%. Pneumonia was diagnosed in 71% and Acute Lung Injury (ALI)/Adult Respiratory Distress Syndrome (ARDS) in 26% of the patients. Other complications such as severe sepsis (6%), renal failure (1.5%), a coagulation disorder (6%) and liver failure (one patient) were infrequent. Age, GCS, hypotension during the first day of treatment, elevated blood sugar and low albumin predicted an unfavourable outcome. Conclusions: Deviations of key physiological variables and pulmonary complications were frequent in patients suffering from severe head injury. During intensive care treatment, hypotension, elevated blood sugar and hypoalbuminemia are possible independent predictors of an unfavourable outcome.

Journal of Neurosurgery, 2015

T raumaTic brain injury (TBI) is a major cause of morbidity and mortality in both low-and high-in... more T raumaTic brain injury (TBI) is a major cause of morbidity and mortality in both low-and high-income countries. 12 Severity classification of TBI is mostly based on the Glasgow Coma Scale (GCS) score, which is the most-used clinical tool to assess patients with reduced consciousness.

Archives of Physical Medicine and Rehabilitation, Dec 1, 2010

Objective: To explore the magnitude and frequency of cognitive impairment 3 months after moderate... more Objective: To explore the magnitude and frequency of cognitive impairment 3 months after moderate to severe traumatic brain injury (TBI), and to evaluate its relationship to disability at 1-year follow-up. Design: Prospective follow-up study. Setting: Regional level I trauma center. Participants: Patients aged 15 to 65 years with definite TBI, defined as Glasgow Coma Scale score of 3 to 13 and injury documented by magnetic resonance imaging (nϭ59) or computed tomography (nϭ2); healthy volunteers (nϭ47) served as controls. Interventions: Not applicable. Main Outcome Measures: Neuropsychological assessment 3 months postinjury and Glasgow Outcome Scale Extended (GOSE) at 3 and 12 months postinjury. Results: Patients with TBI performed worse than controls, most consistently in terms of information processing speed and verbal memory. However, a maximum of only 43% of patients with TBI had impaired test scores (defined as Ͻ1.5 SD below mean of normative data) on any one measure. Based on a selection of 9 tests, a 0 or 1 impaired score was seen in 46 (98%) of 47 controls, in 20 (57%) of 35 patients with moderate TBI, and in 9 (35%) of 26 patients with severe TBI. At 1 year postinjury, disability (defined as GOSE score Յ6) was present in 57% of those with 2 or more impaired test scores and in 21% of those with 0 or 1 impaired score (Pϭ.005). Conclusions: In this sample of patients with recent, definite TBI and healthy volunteers, we found that TBI affected cognition in moderate as well as severe cases. The presence of cognitive impairment was associated with future disability. However, half of the patients with moderate TBI and even one third of those with severe TBI had a normal cognitive assessment 3 months postinjury.

Journal of Neurotrauma, May 1, 2011

The clinical benefit of early magnetic resonance imaging (MRI) in severe and moderate head injury... more The clinical benefit of early magnetic resonance imaging (MRI) in severe and moderate head injury is unclear. We sought to explore the prognostic value of the depth of lesions depicted with early MRI, and also to describe the prevalence and impact of traumatic brainstem lesions. In a cohort of 159 consecutive patients with moderate to severe head injury (age 5-65 years and surviving the acute phase) admitted to a regional level 1 trauma center, 106 (67%) were examined with MRI within 4 weeks post-injury. Depth of lesions in MRI was categorized as: hemisphere level, central level, and brainstem injury (BSI). The outcome measure was Glasgow Outcome Scale Extended (GOSE) 12 months post-injury. Forty-six percent of patients with severe injuries and 14% of patients with moderate injuries had BSI. In severe head injury, central or brainstem lesions in MRI, together with higher Rotterdam CT score, pupillary dilation, and secondary adverse events were significantly associated with a worse outcome in age-adjusted analyses. Bilateral BSI was strongly associated with a poor outcome in severe injury, with positive and negative predictive values of 0.86 and 0.88, respectively. In moderate injury, only age was significantly associated with outcome in multivariable analyses. Limitations of the current study include lack of blinded outcome evaluations and insufficient statistical power to assess the added prognostic value of MRI when combined with clinical information. We conclude that in patients with severe head injury surviving the acute phase, depth of lesion on the MRI was associated with outcome, and in particular, bilateral brainstem injury was strongly associated with poor outcomes. In moderate head injury, surprisingly, there was no association between MRI findings and outcome when using the GOSE score as outcome measure.

Journal of Neurology, Neurosurgery, and Psychiatry, Aug 29, 2012

To study the evolution of traumatic axonal injury (TAI) detected by structural MRI in patients wi... more To study the evolution of traumatic axonal injury (TAI) detected by structural MRI in patients with moderate and severe traumatic brain injury (TBI) during the first year and relate findings to outcome. 58 patients with TBI (Glasgow Coma Scale score 3-13) were examined with MRI at a median of 7 days, 3 months and 12 months post injury. TAI lesions were evaluated blinded and categorised into three stages based on location: hemispheres, corpus callosum and brainstem. Lesions in T2* weighted gradient echo (GRE), fluid attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) were counted and FLAIR lesion volumes were estimated. Inter-rater reliability score was calculated. Outcome was assessed 12 months post injury using the Glasgow Outcome Scale Extended. In the initial MRI, 31% had brainstem lesions compared with 17% at 3 months (p=0.008). In the FLAIR sequences, number and volumes of lesions were reduced from early to 3 months (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). In T2*GRE sequences, the number of lesions persisted at 3 months but was reduced at 12 months (p=0.007). The number of lesions in DWI and volume of FLAIR lesions on early MRI predicted worse clinical outcome in adjusted analyses (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). This is the first study to demonstrate and quantify attenuation of non-haemorrhagic TAI lesions on structural MRI during the first 3 months after TBI; most importantly, the disappearance of brainstem lesions. Haemorrhagic TAI lesions attenuate first after 3 months. Only early MRI findings predicted clinical outcome after adjustment for other prognostic factors. Hence valuable clinical information may be missed if MRI is performed too late after TBI.

Journal of Neurosurgery: Pediatrics, 2022

Journal of Neurotrauma, 2021

In this prospective cohort study, we investigated associations between acute diffusion tensor ima... more In this prospective cohort study, we investigated associations between acute diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) metrics and persistent post-concussion symptoms (PPCS) 3 months after mild traumatic brain injury (mTBI). Adult patients with mTBI (n = 176) and community controls (n = 78) underwent 3 Tesla magnetic resonance imaging (MRI) within 72 h post-injury, estimation of cognitive reserve at 2 weeks, and PPCS assessment at 3 months. Eight DTI and DKI metrics were examined with Tract-Based Spatial Statistics. Analyses were performed in the total sample in uncomplicated mTBI only (i.e., without lesions on clinical MRI), and with cognitive reserve both controlled for and not. Patients with PPCS (n = 35) had lower fractional anisotropy (in 2.7% of all voxels) and kurtosis fractional anisotropy (in 6.9% of all voxels), and higher radial diffusivity (in 0.3% of all voxels), than patients without PPCS (n = 141). In uncomplicated mTBI, only fractional anisotropy was significantly lower in patients with PPCS. Compared with controls, patients with PPCS had widespread deviations in all diffusion metrics. When including cognitive reserve as a covariate, no significant differences in diffusion metrics between patients with and without PPCS were present, but patients with PPCS still had significantly higher mean, radial, and axial diffusivity than controls. In conclusion, patients who developed PPCS had poorer white matter microstructural integrity acutely after the injury, compared with patients who recovered and healthy controls. Differences became less pronounced when cognitive reserve was controlled for, suggesting that preexisting individual differences in axonal integrity accounted for some of the observed differences.

Journal of Neurotrauma, 2020

Innate immune activation has been attributed a key role in traumatic brain injury (TBI) and succe... more Innate immune activation has been attributed a key role in traumatic brain injury (TBI) and successive morbidity. In mild TBI (mTBI), however, the extent and persistence of innate immune activation are unknown. We determined plasma cytokine level changes over 12 months after an mTBI in hospitalized and non-hospitalized patients compared with community controls; and examined their associations to injury-related and demographic variables at admission. Prospectively, 207 patients presenting to the emergency department (ED) or general practitioner with clinically confirmed mTBI and 82 matched community controls were included. Plasma samples were obtained at admission, after 2 weeks, 3 months, and 12 months. Cytokine levels were analysed with a 27-plex beads-based immunoassay. Brain magnetic resonance imaging (MRI) was performed on all participants. Twelve cytokines were reliably detected. Plasma levels of interferon gamma (IFN-c), interleukin 8 (IL-8), eotaxin, macrophage inflammatory protein-1-beta (MIP-1b), monocyte chemoattractant protein 1 (MCP-1), IL-17A, IL-9, tumor necrosis factor (TNF), and basic fibroblast growth factor (FGFbasic) were significantly increased at all time-points in patients compared with controls, whereas IFN-c-inducing protein 10 (IP-10), platelet-derived growth factor (PDGF), and IL-1ra were not. IL-17A and FGF-basic showed significant increases in patients from admission to follow-up at 3 months, and remained increased at 12 months compared with admission. Interestingly, MRI findings were negatively associated with four cytokines: eotaxin, MIP-1b, IL-9, and IP-10, whereas age was positively associated with nine cytokines: IL-8, eotaxin, MIP-1b, MCP-1, IL-17A, IL-9, TNF, FGFbasic, and IL-1ra. TNF was also increased in those with presence of other injuries. In conclusion, mTBI activated the innate immune system consistently and this is the first study to show that several inflammatory cytokines remain increased for up to 1 year post-injury.

World Neurosurgery, 2018

Patients with moderate TBI exhibit characteristics of significant brain injury. Although few pati... more Patients with moderate TBI exhibit characteristics of significant brain injury. Although few patients died or experienced severe disability, 44% did not experience good recovery, indicating that follow-up is needed. The model is a first step in development of prognostic models for moderate TBI that are valid across centers.

Journal of Neurosurgery, 2019

OBJECTIVEThe authors investigated the association between the cause of injury and the occurrence ... more OBJECTIVEThe authors investigated the association between the cause of injury and the occurrence and grade of traumatic axonal injury (TAI) on clinical MRI in patients with moderate or severe traumatic brain injury (TBI).METHODSData for a total of 396 consecutive patients, aged 7–70 years, with moderate or severe TBI admitted to a level 1 trauma center were prospectively registered. Data were included for analysis from the 219 patients who had MRI performed within 35 days (median 8, IQR 4–17 days) and for whom cause of injury was known. Cause of injury was registered as road traffic accident (RTA) or fall (both with respective subcategories), alpine skiing or snowboarding accident, or violence. The MRI protocol consisted of T2*-weighted gradient echo, FLAIR, and diffusion-weighted imaging scans. TAI lesions were evaluated in a blinded manner and categorized into 3 grades, hemispheric/cerebellar white matter (grade 1), corpus callosum (grade 2), and brainstem (grade 3). The absence o...

Journal of Neurotrauma, 2018

Journal of Neurotrauma, 2019

With an emphasis on traumatic axonal injury (TAI), frequency and evolution of traumatic intracran... more With an emphasis on traumatic axonal injury (TAI), frequency and evolution of traumatic intracranial lesions on 3T clinical magnetic resonance imaging (MRI) were assessed in a combined hospital and community-based study of patients with mild traumatic brain injury (mTBI). The findings were related to post-concussion symptoms (PCS) at 3 and 12 months. Prospectively, 194 patients (16-60 years of age) were recruited from the emergency departments at a level 1 trauma center and a municipal outpatient clinic into the Trondheim mTBI follow-up study. MRI was acquired within 72 h (n = 194) and at 3 (n = 165) and 12 months (n = 152) in patients and community controls (n = 78). The protocol included T2, diffusion weighted imaging, fluid attenuated inversion recovery (FLAIR), and susceptibility weighted imaging (SWI). PCS was assessed with British Columbia Post Concussion Symptom Inventory in patients and controls. Traumatic lesions were present in 12% on very early MRI, and in 5% when computed tomography (CT) was negative. TAI was found in 6% and persisted for 12 months on SWI, whereas TAI lesions on FLAIR disappeared or became less conspicuous on follow-up. PCS occurred in 33% of patients with lesions on MRI and in 19% in patients without lesions at 3 months (p = 0.12) and in 21% with lesions and 14% without lesions at 12 months (p = 0.49). Very early MRI depicted cases of TAI in patients with mTBI with microbleeds persisting for 12 months. Patients with traumatic lesions may have a more protracted recovery, but the study was underpowered to detect significant differences for PCS because of the low frequency of trauma-related MRI lesions.

European Journal of Paediatric Neurology, 2019

Objective: In this study we wanted to estimate population-based rates of incidence and mortality ... more Objective: In this study we wanted to estimate population-based rates of incidence and mortality of moderate and severe traumatic brain injury (TBI) in children in one specific region in Norway. Methods: In the region there are seven acute care hospitals (ACHs) in addition to a Level 1 trauma centre. Of 702 869 inhabitants (2014), 145 395 were children aged 0e16 years. Data were collected during ten years (2004e2014). All children aged 0e16 years with moderate (Glasgow Coma Scale [GCS] score 9e13) or severe (GCS score 8) TBI admitted to the Level 1 trauma centre were prospectively included. Children treated outside the Level 1 trauma centre were retrospectively included from the ACHs. Children who died from TBI prehospitally were included from the National Cause of Death Registry. Poisson regression was used to estimate incidence rate ratios (with a 95% confidence interval) comparing age, sex, and time periods.