Research Reports - Epidemiological trends of traumatic brain injury

PLoS One. 2016 Jan 13;11(1):e0145469. doi: 10.1371/journal.pone.0145469.
eCollection 2016.

Fu TS(1), Jing R(1), Fu WW(1), Cusimano MD(1,)(2).

OBJECTIVES: To 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.
METHODS: A 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.
RESULTS: There 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.
CONCLUSIONS: ED 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. 

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