Research Reports - Increased rates of mild traumatic brain injury among older adults in US emergency departments

J Head Trauma Rehabil. 2015 Oct 16. [Epub ahead of print]

Albrecht JS(1), Hirshon JM, McCunn M, Bechtold KT, Rao V, Simoni-Wastila L, Smith

OBJECTIVE: To estimate rates of emergency department (ED) visits for mild
traumatic brain injury (TBI) among older adults. We defined possible mild TBI
cases to assess underdiagnoses.
DESIGN: Cross-sectional.
SETTING: National sample of ED visits in 2009-2010 captured by the National
Hospital Ambulatory Medical Care Survey.
PARTICIPANTS: Aged 65 years and older.
MEASUREMENTS: Mild TBI defined by International Classification of Diseases, Ninth
Revision, Clinical Modification, codes (800.0x-801.9x, 803.xx, 804.xx,
850.xx-854.1x, 950.1x-950.3x, 959.01) and a Glasgow Coma Scale score of 14 or
more or missing, excluding those admitted to the hospital. Possible mild TBI was
defined similarly among those without mild TBI and with a fall or motor vehicle
collision as cause of injury. We calculated rates of mild TBI and examined
factors associated with a diagnosis of mild TBI.
RESULTS: Rates of ED visits for mild TBI were 386 per 100 000 among those aged 65
to 74 years, 777 per 100 000 among those aged 75 to 84 years, and 1205 per 100
000 among those older than 84 years. Rates for women (706/100 000) were higher
than for men (516/100 000). Compared with a possible mild TBI, a diagnosis of
mild TBI was more likely in the West (odds ratio = 2.31; 95% confidence interval,
1.02-5.24) and less likely in the South/Midwest (odds ratio = 0.52; 95%
confidence interval, 0.29-0.96) than in the Northeast.
CONCLUSIONS: This study highlights an upward trend in rates of ED visits for mild
TBI among older adults. 

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