To estimate the prevalence of long-term disability associated with traumatic brain injury (TBI) in the civilian population of the United States.
We first estimated how many people experienced ...long-term disability from TBI each year in the past 70 years. Then, accounting for the increased mortality among TBI survivors, we estimated their life expectancy and calculated how many were expected to be alive in 2005.
An estimated 1.1% of the US civilian population or 3.17 million people (95% CI: 3.02-3.32 million) were living with a long-term disability from TBI at the beginning of 2005. Under less conservative assumptions about TBI's impact on lifespan, this estimate is 3.32 million (95% CI: 3.16-3.48 million).
Substantial long-term disability occurs among the US civilians hospitalized with a TBI.
Develop and validate a predictive model of the incidence of long-term disability following traumatic brain injury (TBI) and obtain national estimates for the United States in 2003. DATA/METHODS: A ...logistic regression model was built, using a population-based sample of persons with TBI from the South Carolina Traumatic Brain Injury Follow-up Registry. The regression coefficients were applied to the 2003 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample data to estimate the incidence of long-term disability following traumatic brain injury hospitalization.
Among 288,009 (95% CI, 287,974-288,043) hospitalized TBI survivors in the United States in 2003, an estimated 124,626 (95% CI, 123,706-125,546) had developed long-term disability.
TBI-related disability is a significant public health problem in the United States. The substantial incidence suggests the need for comprehensive rehabilitative care and services to maximize the potential of persons with TBI.
The epidemiology of traumatic brain injury Corrigan, John D; Selassie, Anbesaw W; Orman, Jean A Langlois
The journal of head trauma rehabilitation,
03/2010, Volume:
25, Issue:
2
Journal Article
Peer reviewed
To describe the most recent estimates of the incidence and prevalence of traumatic brain injury (TBI) and review current issues related to measurement and use of these data.
State of the science ...literature for the United States and abroad was analyzed and issues were identified for (1) incidence of TBI, (2) prevalence of lifetime history of TBI, and (3) incidence and prevalence of disability associated with TBI.
The most recent estimates indicate that each year 235 000 Americans are hospitalized for nonfatal TBI, 1.1 million are treated in emergency departments, and 50 000 die. The northern Finland birth cohort found that 3.8% of the population had experienced at least 1 hospitalization due to TBI by 35 years of age. The Christchurch New Zealand birth cohort found that by 25 years of age 31.6% of the population had experienced at least 1 TBI, requiring medical attention (hospitalization, emergency department, or physician office). An estimated 43.3% of Americans have residual disability 1 year after hospitalization with TBI. corrected The most recent estimate of the prevalence of US civilian residents living with disability following hospitalization with TBI is 3.2 million.
Estimates of the incidence and prevalence of TBI are based on varying sources of data, methods of calculation, and assumptions. Informed users should be cognizant of the limitations of these estimates when determining their applicability.
Abstract Purpose Few studies of sport-related traumatic brain injury (TBI) are population-based or rely on directly observed data on cause, demographic characteristics, and severity. This study ...addresses the epidemiology of sport-related TBI in a large population. Methods Data on all South Carolina hospital and emergency department encounters for TBI, 1998–2011, were analyzed. Annual incidence rate of sport-related TBI was calculated, and rates were compared across demographic groups. Sport-related TBI severity was modeled as a function of demographic and TBI characteristics using logistic regression. Results A total of 16,642 individuals with sport-related TBI yielded an average annual incidence rate of 31.5/100,000 population with a steady increase from 19.7 in 1998 to 45.6 in 2011. The most common mechanisms of sport-related TBI were kicked in football (38.1%), followed by fall injuries in sports (20.3%). Incidence rate was greatest in adolescents ages 12-18 (120.6/100,000/persons). Severe sport-related TBI was strongly associated with off-road vehicular sport (odds ratio OR, 4.73; 95% confidence interval 95% CI, 2.92−7.67); repeated head trauma (OR, 4.36; 95% CI, 3.69−5.15); equestrian sport (OR, 2.73; 95% CI, 1.64−4.51); and falls during sport activities (OR, 2.72; 95% CI, 1.67−4.46). Conclusions The high incidence of sport-related TBI in youth, potential for repetitive mild TBI, and its long-term consequences on learning warrants coordinated surveillance activities and population-based outcome studies.
Highlights • Absolute risk increase of comorbidity was 18.5% higher in epilepsy than in migraine. • Neurodevelopmental comorbidities showed the strongest association with epilepsy. • The absolute ...risk increase of death was 233.3% higher in epilepsy than in migraine. • Of somatic comorbidities, stroke showed the strongest association with epilepsy. • Depression and anxiety were the most prevalent psychiatric comorbidities in epilepsy.
Summary
Purpose: This study was undertaken to determine the risk of developing posttraumatic epilepsy (PTE) within 3 years after discharge among a population‐based sample of older adolescents and ...adults hospitalized with traumatic brain injury (TBI) in South Carolina. It also identifies characteristics related to development of PTE within this population.
Methods: A stratified random sample of persons aged 15 and older with TBI was selected from the South Carolina nonfederal hospital discharge dataset for four consecutive years. Medical records of recruits were reviewed, and they participated in up to three yearly follow‐up telephone interviews.
Results: The cumulative incidence of PTE in the first 3 years after discharge, after adjusting for loss to follow‐up, was 4.4 per 100 persons over 3 years for hospitalized mild TBI, 7.6 for moderate, and 13.6 for severe. Those with severe TBI, posttraumatic seizures prior to discharge, and a history of depression were most at risk for PTE. This higher risk group also included persons with three or more chronic medical conditions at discharge.
Discussion: These results raise the possibility that although some of the characteristics related to development of PTE are nonmodifiable, other factors, such as depression, might be altered with intervention. Further research into factors associated with developing PTE could lead to risk‐reducing treatments.
Aim
To determine the distribution and risk characteristics of comorbid neurodevelopmental and mental health comorbidities among children and adolescents (6–18y) with epilepsy or migraine (i.e. a ...neurological condition with shared features and potential etiology) compared with lower extremity fracture (LEF).
Method
This case–control study involved a subset analysis of surveillance data in South Carolina, USA. Hospital admission, outpatient, and emergency department visits for individuals with an International Classification of Disease, 9th revision Clinical Modification diagnosis of epilepsy (n=6730; 54.5% females, 45.5% males; mean age SD 14y 2mo 4y 5mo); migraine (n=10 495; 74.5% females, 25.5% males; 15y 6mo 2y 6mo), or LEF (n=15 305; 40.3% females, 59.7% males; 13y 11mo 2y 11mo) from January 1 2000 to December 31 2011 were identified. The association of epilepsy, migraine, or LEF with any mental health comorbidity was evaluated with univariate and multivariate polytomous logistic regression.
Results
Comorbidities were highly prevalent in children and adolescents, with epilepsy with a rate of 29.7% (95% confidence interval CI: 28.6–30.8) for mental health comorbidities and 30.8% (95% CI: 29.7–31.9) for neurodevelopmental comorbidities. The odds of mental health comorbidity was 2.20 (95% CI: 2.02–2.39) for children and adolescents with epilepsy and 1.60 (95% CI: 1.48–1.73) for migraine, in reference to children and adolescents with LEF after adjusting for potential confounders. Prevalence and risk for specific comorbidities are presented.
Interpretation
Neuropathophysiological and psychosocial factors specific to epilepsy may provide more risk for adolescents with epilepsy compared to migraine.
What this paper adds
Children and adolescents with epilepsy are at increased risk of comorbidities.
Adolescents with epilepsy are more vulnerable to comorbidities compared to patients with migraines.
This article is commented on by Dan on pages 7–8 of this issue.
Cardiovascular comorbidities of epilepsy such as hypertension, hyperlipidemia, and diabetes are associated with myocardial infarction (MI). Little data on the development of subsequent cardiovascular ...disease (CVD) in persons with epilepsy (PWE) are available, with inconsistent findings regarding the association between epilepsy and subsequent MI. A higher risk of MI among adults (without prior MI) following epilepsy diagnosis compared with that among controls was hypothesized.
This retrospective cohort study used statewide hospital and emergency department (ED) encounter data from 2000–2013 for South Carolina residents aged >18 years without prior MI at the onset of epilepsy, or the first encounter for controls. Persons with epilepsy were compared with 1) persons with migraine (PWM), whose neurological condition has characteristics similar to epilepsy; and 2) persons with isolated lower extremity fracture (PWLF). Subsequent MI was defined as a diagnosis of MI after the first clinical encounter for epilepsy, migraine, or lower extremity fracture (LEF); the association was evaluated with Cox proportional hazard modeling methods.
In this study, 2.2% of PWE, 0.6% of PWM, and 1.2% of PWLF had a subsequent MI. Persons with epilepsy were significantly more likely to be non-Hispanic Black (NHB), be covered by Medicaid, and reside in a rural or low income area compared with PWM and PWLF. Specific cardiovascular disease risk factors were more prevalent in PWE than in PWM and PWLF. After adjustment, the hazard of subsequent MI in PWE was 48% higher than in PWM (hazard ratio (HR) = 1.48; 95% confidence intervals (CI) = 1.31–1.67) and 24% higher than in PWLF (HR = 1.24; 95% CI = 1.10–1.39). The hazard of MI increased with increasing age and number of additional comorbidities and was higher in males, those living in rural areas, and those with specific cardiovascular risk factors.
Persons with epilepsy had moderately elevated risk of subsequent MI compared with PWM or PWLF. The association between epilepsy and MI needs to be further investigated, and clinical care of PWE should include evaluation and management of risk factors for MI.
•Epilepsy comorbidities include cardiovascular disease (CVD) with little known regarding subsequent CVD.•Persons with epilepsy had 24% increased risk of subsequent MI compared with persons with lower extremity fracture.•Persons with migraine had 63% increased risk of subsequent MI compared with persons with lower extremity fracture.•The risk of subsequent MI increased with increasing age and increasing number of comorbidities.
Abstract Objective To investigate risk factors associated with mortality among people with traumatic spinal cord injury (TSCI) after discharge from acute care hospitals in South Carolina and to ...compare their mortality experiences with the general population. Design Retrospective cohort study. Setting Sixty-two acute care, nonfederal hospitals. Participants Persons (N=2685) with TSCI. Interventions Not applicable. Main Outcome Measures Death after TSCI from all causes within 4288 days of observation after discharge from acute care facilities. Results The crude annual mortality rate during the period was 33 per 1000 person-years. Number of comorbidities, admission into trauma centers, advancing age, type of insurance, injury level and completeness, and being a man were significantly associated ( P <.05) with the risk of death after discharge from acute care facilities. The overall mortality rate of our cohort is 3.6 times (95% confidence interval, 3.3–3.9) higher than the general population. Conclusions The causes of postdischarge deaths are multifactorial, and more emphasis should be placed on managing and monitoring chronic diseases throughout the recovery process to improve the survivorship of people with TSCI.
STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To identify predictors of early mortality following traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA.: Limited information is ...available on factors associated with early mortality following TSCI. Ability to identify high risk individuals can help to appropriately treat them, and reduce mortality. METHODS.: Early mortality was defined as death occurring during the initial hospital admission. Retrospective analysis of 1995 patients with TSCI, admitted to various hospitals of South Carolina from 1993 to 2003, was performed. There were 251 patients with early mortality. Multivariable logistic regression was used in modeling of early death following TSCI with gender, race, age, Frankel grade, trauma center, level of injury, injury severity score (ISS), traumatic brain injury (TBI), and medical comorbidities as covariates. RESULTS.: Increasing age after 20 years (OR: 1.2, P = <0.0001), male gender (OR: 1.6, P = 0.016), severe (ISS > or =15) systemic injuries (OR: 1.9, P = 0.012), TBI (OR: 3.7, P < 0.0001), 1 or more comorbidities (P < 0.0001), poor neurologic status (P = 0.015), and level 1 trauma center (OR: 1.4, P = 0.026) were significantly associated with early mortality, after adjusting for other covariates. CONCLUSION.: Early mortality following TSCI is influenced by multiple factors. Timely recognition of these factors is crucial for improving survival in the acute care setting. Severe systemic injuries, medical comorbidities, and TBI continue to be the main limiting factors affecting the outcome. These findings also suggest the need to allocate resources for trauma prevention, and promote research towards improving the care of acutely injured patients.
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