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Incidence, course and risk factors of head injury: a retrospective cohort study.

ABSTRACT: OBJECTIVES:To assess the incidence of head injury and predictors of complication across the care continuum. DESIGN:Retrospective cohort study using data from a research network. We calculated the incidence of overall head injury in a longitudinal cohort covering 1-year interval (31?369 patient-years), and the incidence of complicated head injury in a longitudinal cohort covering 10 years interval (220?352 patient-ears). Incidence rates were calculated per 1000 patient-years with 95%?CI using the Mid-P exact test. We calculated ORs to assess potential risk factors for a complicated head injury. SETTING:A practice-based research network covering a population of >30?000 patients. PARTICIPANTS:All patients listed in practices within the research network during the years 2005-2014. MAIN OUTCOME MEASURES:Incidence of (complicated) head injury and predictors for clinical complications. RESULTS:The incidence of overall head injury was 22.1 per 1000 person-years and the incidence of a complicated course following head injury was 0.16 per 1000 person-years. The following determinants were risk factors for a complicated course: high energy trauma, bicycle accident, traffic accident in general, use of anticoagulants, alcohol intoxication, age above 60 years and low Glasgow Coma Scale at initial presentation. A complicated course was very unlikely when the patients' first encounter with a healthcare professional was in primary care (OR 0.03, 95%?CI 0.01 to 0.07). CONCLUSIONS:Complication after head injury are rarely seen in general practice. Patients who do experience complications are often easily identifiable as requiring specialist care. A more reserved referral policy for general practice may be desirable, suggesting that current guidelines are too defensive.

SUBMITTER: Gerritsen H

PROVIDER: S-EPMC5988084 | biostudies-other | 2018 May

REPOSITORIES: biostudies-other

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Incidence, course and risk factors of head injury: a retrospective cohort study.

Gerritsen Herman H Samim Mariam M Peters Hans H Schers Henk H van de Laar Floris A FA

BMJ open 20180531 5

<h4>Objectives</h4>To assess the incidence of head injury and predictors of complication across the care continuum.<h4>Design</h4>Retrospective cohort study using data from a research network. We calculated the incidence of overall head injury in a longitudinal cohort covering 1-year interval (31 369 patient-years), and the incidence of complicated head injury in a longitudinal cohort covering 10 years interval (220 352 patient-ears). Incidence rates were calculated per 1000 patient-years with 9 ...[more]

PMID: 29858414

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Project description:Introduction: MicroRNAs (miRNAs) are small, non-coding RNA molecules involved in post-transcriptional gene regulation and have recently been shown to play a role in cancer metastasis. In solid tumors, especially breast cancer, alterations in miRNA expression contribute to cancer pathogenesis, including metastasis. Considering the emerging role of miRNAs in metastasis, the identification of predictive markers is necessary to further understanding of stage-specific breast cancer development. This is a retrospective analysis that aimed to identify molecular biomarkers related to distant breast cancer metastasis development.<br><br>Methods: A retrospective case cohort study was performed in 64 breast cancer patients treated during the period from 1998-2001. The case group (n=29) consisted of patients with a poor prognosis who presented with breast cancer recurrence or metastasis during follow up. The control group (n=35) consisted of a random sample of patients with a good prognosis who did not develop breast cancer recurrence or metastasis. These patient groups were stratified according to TNM clinical stage (CS) I, II and III, and the main clinical features of the patients were homogeneous. miRNA profiling was performed using formalin-fixed, paraffin-embedded tumors. Biomarkers related to metastatic potential were identified independent of clinical stage, and a cutoff point was selected based on the optimal sensitivity and specificity (ROC curve). Finally, a hazard risk analysis of these biomarkers was performed to evaluate their relation to metastatic potential. <br><br>Results: miRNA expression profiling identified several miRNAs that were either specific and shared across all clinical stages (p?0.05). Among these, we identified miRNAs previously associated with cell motility (let-7 family), cell proliferation and invasion (hsa-miR-16 and has-miR-205) and distant metastasis (hsa-miR-21). In addition, hsa-miR-494 and hsa-miR-21 were up-regulated in metastatic cases of CSI and II. Furthermore, the combination of the 3 miRNAs identified for CSII (hsa-miR-494, hsa-miR-183 and hsa-miR-21) was significant and were a more effective risk marker compared to the single miRNAs. <br><br>Conclusions: Women with metastatic breast cancer, especially CSII, presented up-regulated levels of miR-183, miR-494 and miR-21, which were associated with a poor prognosis. These miRNAs therefore represent new risk biomarkers of breast cancer metastasis and may be useful for future targeted therapies.

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Incidence, course and risk factors of head injury: a retrospective cohort study.

Publications

Incidence, course and risk factors of head injury: a retrospective cohort study.

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