Traumatic brain injury (TBI) occurs when the brain is injured by external forces – either a blow to the head, or rapid starting/stopping of movement. TBI may be unintentional (accidental) or intentional (inflicted).
Most TBIs are unintentional, and are the leading cause of death and disability in people aged 1-40 years in the UK. In England and Wales, 1.4 million people per year attend emergency departments due to head injury, and approximately half of these are children aged less than 15 years.
TBI, even when mild, can cause long term problems. Mild TBI is commonly known as concussion, and this can lead on to post-concussion syndrome, a condition which affects every aspect of life through physical and psychological symptoms, which may affect social interaction and academic performance. This may be particularly problematic in children whose brains are still developing.
Intentional TBI is also known as abusive head trauma (AHT), which occurs either from violent shaking or blunt impact. This occurs primarily in young children, and AHT is the commonest serious injury in infants under six months of age.
The overall objective of this project is to identify risk factors for (i) abusive head trauma in children under 1 year old, (ii) concussion in children aged 1-17, and (iii) post-concussion syndrome in children aged 1-17.
Results from this study will help medical professionals to reduce the risk of abusive head trauma, concussion, and post-concussion syndrome, and improve outcomes for these children.
Traumatic brain injury (TBI) is the leading cause of death and disability in people aged 1-40 years in the UK. In England and Wales, 1.4 million people attend emergency departments after head injuries annually. Approximately 5-700,000 of these are under 15 years old.
TBI can cause long term problems for the individual, including post-concussion syndrome (PCS). This may be particularly detrimental in children and their families.
Abusive head trauma (AHT) describes deliberately inflicted head injury, causing underlying brain injury. This may be from a direct blow, or shaking (shaken baby syndrome). This preventable condition is the commonest major injury in children under 6 months.
This project’s overall objective is to investigate predictors and outcomes of TBI in children. We will use HES APC and A&E to identify children suffering AHT and those with PCS. ONS mortality data will be used to identify deaths. Patient level IMD will be used to determine socioeconomic position. For children under 1 year old, who are particularly at risk of AHT, we will fit conditional logistic regression models to investigate predictors for AHT. For children aged 1-17, we will use conditional logistic regression to investigate predictors of TBI and Cox Proportional Hazards models to determine predictors of PCS.
The results will help clinicians identify children at risk of AHT, TBI, or developing PCS following concussion, enabling them to put measures in place to reduce risk and improve outcomes for these children. These findings will inform primary prevention (i.e. before the event occurs). Understanding the prevalence, risk factors, and outcomes of TBI can also guide secondary prevention (e.g. more intensive monitoring of patients in at risk group may help identify events promptly where primary prevention did not occur) and tertiary prevention (e.g. better understanding the long term effects of these events, particularly in terms of PCS).
Outcome 1: Prevalence of TBI in infants <1 year old, and the subset which are coded as abusive or have associated domestic abuse codes, in CRPD and HES datasets (see Appendix A for TBI and AHT codes);
Outcome 2: Predictors of abusive head trauma in infants <1 year old: The outcome of interest is abusive head trauma (see Appendix A for TBI and AHT codes);
Outcome 3: Predictors of TBI in children aged 1-17 years. The outcome of interest is TBI (see Appendix A for TBI and AHT codes);
Outcome 4: Predictors for post-concussion syndrome in children aged 1-17 years following a TBI: The outcome of interest is post-concussion syndrome (see Appendix B for PCS codes).
Theresa Redaniel - Chief Investigator - University of Bristol
Joni Jackson - Corresponding Applicant - University of Bristol
- Collaborator -
Aimee White - Collaborator - University Hospitals Bristol NHS Trust
Daisy Gilbert - Collaborator - University of Bristol
Jelena Savovic - Collaborator - University of Bristol
Jialan Hong - Collaborator - University of Bristol
Jo Williams - Collaborator - University of Bristol
Julie Mytton - Collaborator - University Of the West of England
Karina Gosalia - Collaborator - University of Bristol
Lauren Scott - Collaborator - University of Bristol
Mark Lyttle - Collaborator - University Hospitals Bristol NHS Trust
Matthew Booker - Collaborator - University of Bristol
Melissa Benavente - Collaborator - University of Bristol
Rebecca Wilson - Collaborator - University of Bristol
Sharea Ijaz - Collaborator - University of Bristol
Jialan Hong - Collaborator - University of Bristol
Kithsiri Samarakoon - Collaborator - University of Bristol
CPRD Mother-Baby Link;HES Accident and Emergency;HES Admitted Patient Care;HES Diagnostic Imaging Dataset;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation