BACKGROUND Traumatic brain injury (TBI) is an important global public health burden, where those injured by high-energy transfer (e.g., road traffic collisions) are assumed to have more severe injury and are prioritised by emergency medical service trauma triage tools. However recent studies suggest an increasing TBI disease burden in older people injured through low-energy falls. We aimed to assess the prevalence of low-energy falls among patients presenting to hospital with TBI, and to compare their characteristics, care pathways, and outcomes to TBI caused by high-energy trauma. METHODS AND FINDINGS We conducted a comparative cohort study utilising the CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) Registry, which recorded patient demographics, injury, care pathway, and acute care outcome data in 56 acute trauma receiving hospitals across 18 countries (17 countries in Europe and Israel). Patients presenting with TBI and indications for computed tomography (CT) brain scan between 2014 to 2018 were purposively sampled. The main study outcomes were (i) the prevalence of low-energy falls causing TBI within the overall cohort and (ii) comparisons of TBI patients injured by low-energy falls to TBI patients injured by high-energy transfer-in terms of demographic and injury characteristics, care pathways, and hospital mortality. In total, 22,782 eligible patients were enrolled, and study outcomes were analysed for 21,681 TBI patients with known injury mechanism; 40% (95% CI 39% to 41%) (8,622/21,681) of patients with TBI were injured by low-energy falls. Compared to 13,059 patients injured by high-energy transfer (HE cohort), the those injured through low-energy falls (LE cohort) were older (LE cohort, median 74 [IQR 56 to 84] years, versus HE cohort, median 42 [IQR 25 to 60] years; p < 0.001), more often female (LE cohort, 50% [95% CI 48% to 51%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001), more frequently taking pre-injury anticoagulants or/and platelet aggregation inhibitors (LE cohort, 44% [95% CI 42% to 45%], versus HE cohort, 13% [95% CI 11% to 14%]; p < 0.001), and less often presenting with moderately or severely impaired conscious level (LE cohort, 7.8% [95% CI 5.6% to 9.8%], versus HE cohort, 10% [95% CI 8.7% to 12%]; p < 0.001), but had similar in-hospital mortality (LE cohort, 6.3% [95% CI 4.2% to 8.3%], versus HE cohort, 7.0% [95% CI 5.3% to 8.6%]; p = 0.83). The CT brain scan traumatic abnormality rate was 3% lower in the LE cohort (LE cohort, 29% [95% CI 27% to 31%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001); individuals in the LE cohort were 50% less likely to receive critical care (LE cohort, 12% [95% CI 9.5% to 13%], versus HE cohort, 24% [95% CI 23% to 26%]; p < 0.001) or emergency interventions (LE cohort, 7.5% [95% CI 5.4% to 9.5%], versus HE cohort, 13% [95% CI 12% to 15%]; p < 0.001) than patients injured by high-energy transfer. The purposive sampling strategy and censorship of patient outcomes beyond hospital discharge are the main study limitations. CONCLUSIONS We observed that patients sustaining TBI from low-energy falls are an important component of the TBI disease burden and a distinct demographic cohort; further, our findings suggest that energy transfer may not predict intracranial injury or acute care mortality in patients with TBI presenting to hospital. This suggests that factors beyond energy transfer level may be more relevant to prehospital and emergency department TBI triage in older people. A specific focus to improve prevention and care for patients sustaining TBI from low-energy falls is required.

中文翻译：

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CENTER-TBI Registry：一项比较队列研究中，来自 18 个国家/地区的患者因低能量造成的创伤性脑损伤负担下降。

背景创伤性脑损伤 (TBI) 是一种重要的全球公共卫生负担，其中那些因高能量转移（例如，道路交通碰撞）受伤的人被认为具有更严重的伤害，并被紧急医疗服务创伤分类工具优先考虑。然而，最近的研究表明，因低能量跌倒而受伤的老年人的 TBI 疾病负担正在增加。我们旨在评估因 TBI 就诊的患者中低能量跌倒的患病率，并将他们的特征、护理途径和结果与高能量创伤引起的 TBI 进行比较。方法和结果 我们利用 CENTER-TBI（欧洲神经创伤协作 TBI 有效性研究）登记处进行了一项比较队列研究，该登记处记录了患者的人口统计学、损伤、护理途径、以及来自 18 个国家（欧洲和以色列 17 个国家）的 56 家急性创伤接收医院的急性护理结果数据。有目的地对 2014 年至 2018 年间出现 TBI 和计算机断层扫描 (CT) 脑部扫描适应症的患者进行抽样。主要研究结果是 (i) 在整个队列中导致 TBI 的低能量跌倒的流行率和 (ii) 低能量跌倒受伤的 TBI 患者与高能量转移受伤的 TBI 患者在人口统计学和伤特征、护理途径和住院死亡率。总共招募了 22,782 名符合条件的患者，并分析了 21,681 名已知损伤机制的 TBI 患者的研究结果；40% (95% CI 39% to 41%) (8,622/21,681) 的 TBI 患者因低能量跌倒受伤。与13相比，LE 队列的 CT 脑部扫描创伤性异常率低 3%（LE 队列，29% [95% CI 27% 至 31%]，与 HE 队列相比，32% [95% CI 31% 至 34%]；p < 0.001); LE 队列中的个体接受重症监护的可能性降低 50%（LE 队列，12% [95% CI 9.5% 至 13%]，与 HE 队列相比，24% [95% CI 23% 至 26%]；p < 0.001) 或紧急干预（LE 队列，7.5% [95% CI 5.4% 至 9.5%]，与 HE 队列，13% [95% CI 12% 至 15%]；p < 0.001）相比高能量损伤患者转移。有目的的抽样策略和对出院后患者结果的审查是主要的研究局限性。结论 我们观察到，因低能量跌倒而导致 TBI 的患者是 TBI 疾病负担的重要组成部分，也是一个独特的人口队列；更远，我们的研究结果表明，能量转移可能无法预测到医院就诊的 TBI 患者的颅内损伤或急性护理死亡率。这表明能量转移水平以外的因素可能与老年人的院前和急诊科 TBI 分类更相关。需要特别关注改善因低能量跌倒而导致 TBI 的患者的预防和护理。