Violence-Related Traumatic Brain Injury Teemu Luoto MD, PhD, A/Prof Dep. of Neurosurgery Violence-Related Traumatic Brain Injury

Disclosures No interest to disclose PESG and IBIA staff have no interest to disclose This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with IBIA. PESG, IBIA, and all accrediting organization do not support or endorse any product or service mentioned in this activity.

Objectives A substantial number of traumatic brain injuries (TBI) are caused by violence- related incidents The purpose of this study was to determine the unique characteristics of violence-related TBIs with an emphasis on possible preventable risk factors

Methods – 1/2 Methods All consecutive patients who underwent head CT due to an acute head injury were included N = 3,023 The Emergency Department of Tampere University Hospital Aug 2010 - Jul 2012 Tampere

Methods – 2/2 Methods Data collection consisted of Socio-demographics, Injury-related data, and clinical information from the emergency department Patients with a violence-related TBI were identified n = 222 (7 %) A additional detailed retrospective data collection was performed on these patients Statistical comparison: Violence-related TBI VS. Other TBI n=222 n=2801 %

Independent risk factors in adjusted logistic regression Results – 1/3 Methods Results Methods   Violence-related TBI Other TBI p-value OR Age (mean) 35.4 56.5 <0.0001 Male 78.4 54.7 3.0 Prior circulatory system disease 8.1 41.9 0.1 Prior psychiatric disorders 43.7 24.4 2.4 Chronic alcohol abuse 34.2 17.2 2.5 Regular substance abuse 18.5 9.2 Alcohol intox 59.5 21.7 5.3 Narcotics intox 2.7 0.7 0.001 4.1 Acute trauma lesion on head CT 13.1 19.6 0.017 0.6   Violence-related TBI Other TBI p-value OR Age (mean) 35.4 56.5 <0.0001 Male 78.4 54.7 3.0 Prior circulatory system disease 8.1 41.9 0.1 Prior psychiatric disorders 43.7 24.4 2.4 Chronic alcohol abuse 34.2 17.2 2.5 Regular substance abuse 18.5 9.2 Alcohol intox 59.5 21.7 5.3 Narcotics intox 2.7 0.7 0.001 4.1 Acute trauma lesion on head CT 13.1 19.6 0.017 0.6   Violence-Related TBI Other TBI p-value OR Age (mean) 35.4 56.5 <0.0001 Male 78.4 54.7 3.0 Prior circulatory system disease 8.1 41.9 0.1 Prior psychiatric disorders 43.7 24.4 2.4 Chronic alcohol abuse 34.2 17.2 2.5 Regular substance abuse 18.5 9.2 Alcohol intox 59.5 21.7 5.3 Narcotics intox 2.7 0.7 0.001 4.1 Acute trauma lesion on head CT 13.1 19.6 0.017 0.6 Independent risk factors in adjusted logistic regression

No statistically significant difference between groups Results – 2/3 Methods Methods Results Violence-Related TBI vs. Other TBI: TBI severity (mild/mod/sev) Loss of consciousness Post-traumatic amnesia Disorientation Need of neurosurgery No statistically significant difference between groups

Municipalities and suburbs Municipalities and suburbs Results – 3/3 Results Methods Methods Detailed Characteristics of Violence-Related TBI: 62% 62% ? Unknown assaulter 73% ? Unknown assaulter 73% Municipalities and suburbs 64% Municipalities and suburbs 64% 10pm – 4am 53% 10pm – 4am 53% Streets 31% Homes 16% Restaurants/bars 13% Streets 31% Homes 16% Restaurants/bars 13%

Conclusions Methods Methods Results Conclusions Young adult males with premorbid mental health history (incl. chronic alcohol abuse) are most prone to sustain a TBI due to a violence-related incident These incidents are often related to alcohol intoxication, and occur on nighttime streets Violence was not associated with more severe TBIs than other mechanisms of injury Preventive measures should be focused on alcohol consumption 1 2 3 4

Collaborators Methods Methods Results Conclusions Tuomas Mäntykoski, MD University of Tampere, Tampere, Finland Juuli Renko, BM Grant L. Iverson, PhD, professor Harvard Medical School, Boston, MA, USA Juha Öhman, MD, PhD, professor Tampere University Hospital, Tampere, Finland