Unintentional Traumatic Brain Injury Research Articles

QuickStats: Rate* of Unintentional Traumatic Brain Injury (TBI)-Related Deaths† Among Persons Aged ≤24 Years, by Age Group - National Vital Statistics System, United States, 1999-2018.

QuickStats: Rate* of Unintentional Traumatic Brain Injury (TBI)-Related Deaths† Among Persons Aged ≤24 Years, by Age Group - National Vital Statistics System, United States, 1999-2018.

A Spatial Analysis of Health Disparities Associated with Antibiotic Resistant Infections in Children Living in Atlanta (2002-2010).

Background:Antibiotic resistant bacteria like community-onset methicillin resistant Staphylococcus aureus (CO-MRSA) have continued to cause infections in children at alarming rates and are associated with health disparities. Geospatial analyses of individual and area level data can enhance disease surveillance and identify socio-demographic and geographic indicators to explain CO-MRSA disease transmission patterns and risks.Methods:A case control epidemiology approach was undertaken to compare children with CO-MRSA to a noninfectious condition (unintentional traumatic brain injury (uTBI)). In order to better understand the impact of place based risks in developing these types of infections, data from electronic health records (EHR) were obtained from CO-MRSA cases and compared to EHR data from controls (uTBI). US Census data was used to determine area level data. Multi-level statistical models were performed using risk factors determined a priori and geospatial analyses were conducted and mapped.Results:From 2002–2010, 4,613 with CO-MRSA and 34,758 with uTBI were seen from two pediatric hospitals in Atlanta, Georgia. Hispanic children had reduced odds of infection; females and public health insurance were more likely to have CO-MRSA. Spatial analyses indicate significant ‘hot spots’ for CO-MRSA and the overall spatial cluster locations, differed between CO-MRSA cases and uTBI controls.Conclusions:Differences exist in race, age, and type of health insurance between CO-MRSA cases compared to noninfectious control group. Geographic clustering of cases is distinct from controls, suggesting placed based factors impact risk for CO-MRSA infection.

Emergency Department Visits Owing to Intentional and Unintentional Traumatic Brain Injury among Infants in the United States: A Population-Based Assessment

To examine national trends of emergency department (ED) visits owing to traumatic brain injury (TBI) among infants (age <12 months), specifically in the context of intentional and unintentional mechanisms. National Electronic Injury Surveillance System-All Injury Program data documenting nonfatal ED visits from 2003 to 2012 were analyzed. TBI was defined as ED visits resulting in a diagnosis of concussion, or fracture, or internal injury of the head. Intentional and unintentional injury mechanisms were compared using multivariable models. Joinpoint regression was used to identify significant time trends. TBI-related ED visits (estimated n = 713 124) accounted for 28% of all injury-related ED visits by infants in the US, yielding an average annual rate of 1722 TBI-related ED visits per 100 000 infants. Trend analysis showed an annual increase of 9.48% in the rate of TBI-related ED visits over 10 years (P < .05). For these visits, an estimated 701 757 (98.4%) were attributed to unintentional mechanisms and 11 367 (1.6%) to intentional mechanisms. Unintentional TBI-related ED visit rates increased by 9.52% annually (P < .05) and the rates of intentional TBI were relatively stable from 2003 to 2012. Infants with intentional TBI were more likely to be admitted (aOR, 11.44; 95% CI, 3.02-21.75) compared with those with unintentional TBI. The rate of TBI-related ED visits in infants increased primarily owing to unintentional mechanisms and intentional TBI-related ED visits remained stable over the decade. Improved strategies to reduce both intentional and unintentional injuries in infants are required.

Racial/Ethnic and Insurance Status Disparities in Discharge to Posthospitalization Care for Patients With Traumatic Brain Injury

Professional, posthospitalization care (PHC) can improve outcomes among patients with traumatic brain injury. We examined disparities in discharge to PHC by patients' race/ethnicity and insurance type. A total of 6061 adults hospitalized for unintentional traumatic brain injury in Oregon, 2008 to 2011. Posthospitalization care was assessed on the basis of discharge disposition. Multivariable logistic regression was used to estimate effects of race/ethnicity and insurance on referral to PHC while controlling for potential confounders. Generalized estimating equations were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), accounting for clustering of data by hospital. 28% of patients were discharged to PHC. While controlling for potential confounders, Hispanics were less likely to be discharged to PHC (OR, 0.62; CI, 0.40-0.96) than non-Hispanic whites. Compared with patients with private insurance, uninsured patients were less likely to be discharged to PHC (OR, 0.19; CI, 0.11-0.32) whereas patients with public insurance (OR, 1.65; CI, 1.33-2.05) and worker's compensation (OR, 1.66; CI, 1.09-2.52) were more likely to be discharged to PHC. Results suggest that racial/ethnic and insurance disparities exist in discharge to postacute care after hospitalization for traumatic brain injury. Future research should examine factors that might contribute to and reduce these inequities in care.

Community integration outcomes after traumatic brain injury due to physical assault

Community integration is considered an ultimate goal for rehabilitation after traumatic brain injury (TBI). To determine (a) whether differences exist in rehabilitation outcomes between intentional and unintentional TBI populations and (b) whether TBI from assault is a predictor of community integration following inpatient rehabilitation. Retrospective cohort study using population-based data from Canadian hospital administration records, 2001 to 2006. Outcome measure was the Reintegration to Normal Living Index (RNLI). From a sample of 243 persons, 24 (9.9%) had sustained TBI from physical assault. Persons with TBI from physical assault reported significantly lower scores on two items on the RNLI's Daily Functioning subscale: "recreation" and "family role." These findings suggest that targeted intervention in these specific areas could be beneficial, which are often primarily addressed by occupational therapists in both inpatient rehabilitation and community settings.

Discharge Against Medical Advice After Traumatic Brain Injury: Is Intentional Injury a Predictor?

Discharge against medical advice (DAMA) have consistently been reported as causing adverse outcomes for both patients and service providers. However, little is known about the DAMA of patients with traumatic brain injury (TBI). The objectives of this study were to develop a risk profile of DAMA patients in the TBI population, to examine factors associated with DAMA occurrence, and to examine specifically whether injury intention (unintentional vs. intentional) is a significant predictor of DAMA. A retrospective cohort study was conducted using hospital discharge data obtained from the Minimal Data Set (MDS) of the Ontario Trauma Registry for the years 1993/1994 and 2000/2001 on TBI patients aged 15 to 64 years. The MDS review yielded 15,684 cases of TBI with an average length of stay of 2.7 days. Of these, 446 (2.84%) had recorded DAMA events. When compared with patients with unintentional TBI, DAMA was significantly associated with intentional injuries in those with self-inflicted TBI (adjusted odds ratio [aOR] = 1.97; 95% confidence interval [CI], 1.36-2.84) and other-inflicted TBI (aOR = 2.00; CI, 1.53-2.62). DAMA was also associated with younger age and a history of alcohol/drug abuse (aOR = 3.50; CI, 2.85-4.30). TBI patients who leave hospital against medical advice are a high-risk population. Early identification of these patients could allow implementation of better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.

Intentional Traumatic Brain Injury in Ontario, Canada

Violence and traumatic brain injury (TBI) are two major public health concerns. This violence-related TBI, however, has not been studied in Canada and there is little literature on a profile of risk factors and injury severity regarding TBI because of self-inflicted/suicidal and assault/homicidal injury compared with unintentional TBI. Cross-sectional study using the comprehensive data set (CDS) of Ontario trauma registry (OTR) from 1993 to 2001. Data from a large trauma registry were used to assess demographic and injury-related characteristics, injury severity and incident time associated with TBI that were either caused unintentionally, were self-inflicted or resulted from an assault. This study identified 1,409 (8.0%) intentional TBIs and 16,211 (92.0%) unintentional TBIs. Of the intentional TBIs, 389 (27.6%) was self-inflicted TBI (Si-TBI) and 1,020 (72.4%) was other-inflicted TBI (Oi-TBI). The most common cause of Si-TBI was "jumping from high places" (32.1%), followed by "firearms" (30.6%). About half of Oi-TBI was because of "fight and brawl" (48.3%), followed by "struck by objects" (26.1%). Si-TBI was associated with younger age, female gender, and having more alcohol/drug abuse history. For Oi-TBI, younger age, male gender, having more alcohol/drug abuse history were independently associated. This research provides the first comprehensive overview of intentional TBI based on Canadian data. The CDS of the OTR provided the ability to identify who is at risk for intentional TBI. Prevention programs and more targeted rehabilitation services should be designed for this vulnerable population.

Blame attribution in intentional and unintentional traumatic brain injury: Longitudinal changes and impact on subjective well-being.

Objective: Examine longitudinal changes in attribution of blame to self and others, and concern over cause of injury, in both intentional (violence-related) and unintentional (accidental) traumatic brain injury (TBI); investigate the relation of these factors to subjective well-being outcomes at 1 year post-TBI. Study Design: Prospective, multicenter, observational study with longitudinal component. Participants: 99 men with unintentional TBI and 25 men with intentional TBI who sustained moderate to severe injuries, received inpatient rehabilitation, and provided data in both acute rehabilitation and 1-year follow-up. Measures: Blame Attribution Questionnaire, General Health Questionnaire-30, Neurobehavioral Functioning Inventory--Revised Depression Scale, Satisfaction With Life Scale, community participation measures. Results: At both time points, participants with intentional TBI blamed others more while those with unintentional TBI blamed themselves more (trend). Other-blame at 1 year predicted depression but not life satisfaction. Self-blame was not a significant predictor of depression or life satisfaction. Increasing concern over cause/blame for injury from acute rehabilitation to follow-up was associated with high levels of emotional distress. Conclusion: Blame attribution issues may be markers of TBI-related emotional distress regardless of injury etiology, particularly when others are blamed for the injury and/or concerns over cause of injury do not resolve over time.

Prehospital and In-Hospital Mortality

To describe the incidence and case-fatality rates of traumatic brain injury (TBI) in young children in Colorado, to compare these injuries based on intentionality and outcome (prehospital death, in-hospital death, or survival), and to model the association of intentionality with TBI-related mortality. Cases were drawn from the 1994-2002 Colorado Traumatic Brain Injury Surveillance System. Incidence and case-fatality rates for intentional and unintentional TBI were calculated. We performed univariate comparisons based on the intentionality and outcome of the TBI. Multivariate logistic regression was used to estimate the association of intentionality and mortality, controlling for injury severity. Of the 1333 children aged 0 to 36 months with TBI, 340 had intentional and 993 had unintentional TBI. Incidence for intentional and unintentional TBI was 16.1 and 47.0 per 100,000, respectively. Children with intentional TBI had a higher case-fatality rate, in-hospital death rate, and injury severity. Intentional TBI deaths were twice as likely to occur in hospital than prehospital, whereas unintentional TBI deaths were twice as likely to occur prehospital. Intentionality was significantly associated with mortality, with the effect increasing with increasing age. Intentionality--independent of severity--raises the mortality of TBI in young children.

Inflicted Traumatic Brain Injury in Young Children

Source: Keenan HT, Runyan DK, Marshall SW, et al. A population-based study of inflicted traumatic brain injury in young children. JAMA. 2003;290:621–626.To ascertain the incidence of serious inflicted traumatic brain injury (TBI), the authors from the University of North Carolina at Chapel Hill, North Carolina, prospectively studied all children ≤2 years of age who were admitted to a pediatric intensive care unit (PICU) in the state of North Carolina between January 2000 and December 2001 with TBI. The authors also monitored the 3 closest out-of-state PICUs during the study for admission of North Carolina residents who met study criteria. Information was obtained from the North Carolina Office of the Chief Medical Examiner to identify children who died without admission to a PICU or prior to hospital admission.A diagnosis of inflicted injury required evidence of TBI accompanied by a confession or a medical and child protective services determination that the injury was inflicted. This assessment was made by the treating providers at each hospital and was reviewed by 2 of the study authors. The incidence of inflicted TBI and non-inflicted TBI was calculated. Children with inflicted TBI were compared to those with non-inflicted TBI and to the general population of children without TBI (North Carolina birth certificate information).A total of 152 cases of TBI were identified, of which 53% were inflicted. The incidence of inflicted TBI for children ≤2 years that resulted in death or admission to a PICU was 17.0/100,000 person years. Children <1 year of age had a higher rate of inflicted TBI than children 1–2 years of age (29.7 versus 3.8/100,000 person years). Boys had higher rates of inflicted TBI than girls (21.0 versus 13.0/100,000 person years). The median age of patients with inflicted TBI was 4.0 months compared to 7.5 months for patients with non-inflicted TBI.Relative to the general population of North Carolina, children with inflicted injury were more likely to have young mothers (≤21 years) (OR 4.7; 95% CI, 1.9–11.4); to be non-white (OR 2.1; 95% CI, 1.1–4.2 for African Americans and OR 6.0; 95% CI, 2.2–16.8 for other minorities); to be male (OR 2.0; 95% CI, 1.1–3.9); or to be the product of multiple births (OR 5.0; 95% CI, 1.2–21.5).Approximately 1,300 children in the United States die each year due to maltreatment.1 Many of these children are infant victims of inflicted TBI. Children who survive often have serious neurological consequences. The medical and societal costs to care for these children acutely and during their rehabilitation are extensive.2 However, the scope of the problem has been difficult to measure, as definitions and reporting of TBI have been inconsistent.This prospective, population-based study is the first to report the incidence of serious inflicted TBI in children under the age of 2 years in a US population. As the authors acknowledge, the study underestimates the incidence of all inflicted TBI, as only children who were monitored in an intensive care unit or who died were included in the study. Milder cases of TBI may not present for medical care, and may be misdiagnosed when they do present.3 Many of these children may also have long-lasting neurological or educational disabilities.2This study demonstrates that inflicted traumatic brain injury is a serious public health concern. Follow-up of this cohort will help assess whether the outcome of inflicted TBI is, in fact, worse than unintentional TBI. Treatment and outcome of brain-injured infants have not been studied and current recommendations for TBI treatment are based on studies of older children and adults.4 Armed with a new estimate of the incidence of serious TBI, as well as estimates of the extensive associated medical and societal costs, more convincing arguments can now be made to find and fund effective prevention efforts. Knowledge of the epidemiology of TBI may help target such efforts.This report constitutes another in a series of heads-up alerts regarding the extent and enormous societal costs of child maltreatment. Prevention is a formidable challenge. We believe it requires transforming our communities into child-friendly environments that can intercept the victims of abuse and block the transfer of that terrible legacy on to the next generation.