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Inzidenz und Outcome nach relevantem Schädel-Hirn-Trauma

Eine epidemiologische Untersuchung im Stadtgebiet einer westdeutschen Großstadt über einen Zeitraum von 10 Jahren

The incidence and outcome after relevant traumatic brain injury

An epidemiological study in an urban center of one million inhabitants in western Germany over 10 years

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Zusammenfassung

Hintergrund

Die bislang vorgelegten Daten zur Inzidenz und zum Outcome nach Schädel-Hirn-Trauma (SHT) zeigen eine große Variabilität. Die vorliegende Untersuchung wurde durchgeführt, um aktuelle Daten und Entwicklungen in Bezug auf die Inzidenz, die Schwere und das Outcome nach SHT am Beispiel einer westdeutschen Großstadt mit etwa 1 Mio. Einwohnern aufzuzeigen.

Patienten und Methoden

Insgesamt wurden 130.000 Dokumentationsprotokolle von Einsätzen des Rettungsdiensts der Berufsfeuerwehr der Stadt Köln zwischen dem 1. Januar 1990 und dem 31. Dezember 1999, d. h. über einen Zeitraum von 10 Jahren, auf das Vorliegen eines SHT gesichtet. In die Auswertung eingeschlossen wurden Patienten mit einer initialen „Glasgow Coma Scale“ (GCS) ≤8 am Unfallort und/oder einer „Abbreviated Injury Scale“ für die Körperregion Kopf (AISKopf) ≥2 mit via adäquater Diagnostik gesichertem SHT.

Ergebnisse

Die jährliche Inzidenz des relevanten SHT im geographischen Stadtgebiet der Großstadt Köln betrug 7,3/100.000. Die Gesamtmortalität lag bei 45,8%: 128 Patienten (28%) verstarben vor Eintreffen in der Klinik, 116 (17,8%) verstarben im Krankenhaus. 214 von 352 (60,8%) überlebenden Patienten waren zum Zeitpunkt ihrer Entlassung zufriedenstellend rehabilitiert („Glasgow Outcome Scale“, GOS=1), 138 Patienten (39,2%) überlebten mit persistierenden Einschränkungen. Dabei war die GOS zum Zeitpunkt der Entlassung mit den initialen GCS- und AISKopf-Werten assoziiert.

Schlussfolgerungen

Im Vergleich zu früheren Untersuchungen war die Inzidenz des SHT in der vorliegenden Untersuchung niedriger. Die Gesamtsterblichkeit war hoch, insbesondere im Rahmen der prähospitalen und frühen Krankenhausphase.

Abstract

Background

Valid epidemiological data on the incidence and outcome of traumatic brain injury (TBI) show great variability. A 10-year study on the incidence, severity and outcome of relevant TBI was conducted in an urban area of one million inhabitants in western Germany, the city of Cologne.

Patients and methods

A total of 130,000 prehospital emergencies carried out at the city of Cologne emergency medical service between 1st January 1990 and 31st December, 1999 were screened for TBI. Inclusion criteria were a GCS (Glasgow Coma Scale) ≤8 and/or AIShead (Abbreviated injury scale for the head) ≥2 with confirmed TBI via appropriate diagnostic procedures.

Results

The annual incidence of relevant TBI was 7.3/100,000. The overall mortality rate was 45.8%, pre-hospital deaths totaled 182 (28%), 116 patients (17.8%) died in hospital. Of the surviving patients 214 out of 352 (60.8%) were sufficiently rehabilitated at discharge (GOS=1), but 138 patients (39.2%) survived with persisting deficits. GOS was correlated to initial GCS and AIShead values.

Conclusions

The incidence of TBI was lower compared to the figures in the literature but the overall mortality was high, especially in the pre- and early in-hospital periods.

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Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht. Es wird darauf hingewiesen, dass die vorliegende Arbeit bereits in Teilen publiziert wurde (Maegele et al. (2007) Eur Surg Res 39: 372–379).

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, Klinikum Köln-Merheim der Kliniken der Stadt Köln, Universität Witten-Herdecke gGmbH, Ostmerheimerstrasse 200, 51109, Köln, Deutschland

    M. Maegele, D. Engel, M. Raum & B. Bouillon

  2. Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten-Herdecke gGmbH, Köln, Deutschland

    M. Maegele, R. Lefering, H. Fach, A. Höffgen, H. Doll & E. Neugebauer

  3. Department of Neurosurgery, Erasmus Medical Center, Rotterdam, Niederlande

    D. Engel

  4. Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Köln, Deutschland

    B. Buchheister

  5. Klinik für Neurochirurgie, Universität zu Köln, Köln, Deutschland

    N. Klug

  6. Klinik für Neurochirurgie, Klinikum Köln-Merheim, Kliniken der Stadt Köln, Köln, Deutschland

    F. Weber

Authors
  1. M. Maegele
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  2. R. Lefering
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  3. H. Fach
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  4. D. Engel
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  5. M. Raum
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  6. B. Buchheister
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  7. A. Höffgen
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  8. H. Doll
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  9. N. Klug
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  10. F. Weber
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  11. E. Neugebauer
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  12. B. Bouillon
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Correspondence to M. Maegele.

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Maegele, M., Lefering, R., Fach, H. et al. Inzidenz und Outcome nach relevantem Schädel-Hirn-Trauma. Notfall Rettungsmed 11, 266–272 (2008). https://doi.org/10.1007/s10049-008-1060-6

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