Epidemiological Trends of Traumatic Brain Injury Identified in the Emergency Department in a Publicly-Insured Population, 2002-2010.

Terence S Fu,Ruwei Jing,Wayne W Fu,Michael D Cusimano,Sheila Alexander

doi:10.1371/journal.pone.0145469

Terence S Fu, Ruwei Jing + Show 3 more

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https://doi.org/10.1371/journal.pone.0145469

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Abstract

ObjectivesTo examine epidemiological trends of Traumatic Brain Injury (TBI) treated in the Emergency Department (ED), identify demographic groups at risk of TBI, and determine the factors associated with hospitalization following an ED visit for TBI.MethodsA province-wide database was used to identify all ED visits for TBI in Ontario, Canada between April 2002 and March 2010. Trends were analyzed using linear regression, and predictors of hospital admission were evaluated using logistic regression.ResultsThere were 986,194 ED visits for TBI over the eight-year study period, resulting in 49,290 hospitalizations and 1,072 deaths. The age- and sex-adjusted rate of TBI decreased by 3%, from 1,013.9 per 100,000 (95% CI 1,008.3–1,010.6) to 979.1 per 100,000 (95% CI 973.7–984.4; p = 0.11). We found trends towards increasing age, comorbidity level, length of stay, and ambulatory transport use. Children and young adults (ages 5–24) sustained peak rates of motor vehicle crash (MVC) and bicyclist-related TBI, but also experienced the greatest decline in these rates (p = 0.003 and p = 0.005). In contrast, peak rates of fall-related TBI occurred among the youngest (ages 0–4) and oldest (ages 85+) segments of the population, but rates remained stable over time (p = 0.52 and 0.54). The 5–24 age group also sustained the highest rates of sports-related TBI but rates remained stable (p = 0.80). On multivariate analysis, the odds of hospital admission decreased by 1% for each year over the study period (OR = 0.991, 95% CI = 0.987–0.995). Increasing age and comorbidity, male sex, and ambulatory transport were significant predictors of hospital admission.ConclusionsED visits for TBI are involving older populations with increasingly complex comorbidities. While TBI rates are either stable or declining among vulnerable groups such as young drivers, youth athletes, and the elderly, these populations remain key targets for focused injury prevention and surveillance. Clinicians in the ED setting should be cognizant of factors associated with hospitalization following TBI.Level of EvidenceIII.Study DesignCross-sectional.

Highlights

Traumatic brain injury (TBI) is a major cause of traumatic death and disability globally, and requires ongoing prevention and surveillance
The age- and sex-adjusted rate of TBI decreased by 3%, from 1,013.9 per 100,000 to 979.1 per 100,000
Peak rates of fall-related TBI occurred among the youngest and oldest segments of the population, but rates remained stable over time (p = 0.52 and 0.54)

Summary

Introduction

Traumatic brain injury (TBI) is a major cause of traumatic death and disability globally, and requires ongoing prevention and surveillance. In the United States, 1.7 million TBIs occur annually, and an estimated 2% of the population lives with a TBI-related disability [1]. 80–92% of TBIs are treated in the Emergency Department (ED) [1, 4]. There are 1.3 million ED visits for TBI in the US, resulting in $5.8 billion (USD) in direct healthcare costs alone [1, 5]. Studies have shown a recent surge in ED visits related to TBI the cause of this rise is unclear [1, 6, 7]

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