Traumatic brain injury (TBI) is seen by the insurance industry and many health care providers as an "event." Once treated and provided with a brief period of rehabilitation, the perception exists ...that patients with a TBI require little further treatment and face no lasting effects on the central nervous system or other organ systems. In fact, TBI is a chronic disease process, one that fits the World Health Organization definition as having one or more of the following characteristics: it is permanent, caused by non-reversible pathological alterations, requires special training of the patient for rehabilitation, and/or may require a long period of observation, supervision, or care. TBI increases long-term mortality and reduces life expectancy. It is associated with increased incidences of seizures, sleep disorders, neurodegenerative diseases, neuroendocrine dysregulation, and psychiatric diseases, as well as non-neurological disorders such as sexual dysfunction, bladder and bowel incontinence, and systemic metabolic dysregulation that may arise and/or persist for months to years post-injury. The purpose of this article is to encourage the classification of TBI as the beginning of an ongoing, perhaps lifelong process, that impacts multiple organ systems and may be disease causative and accelerative. Our intent is not to discourage patients with TBI or their families and caregivers, but rather to emphasize that TBI should be managed as a chronic disease and defined as such by health care and insurance providers. Furthermore, if the chronic nature of TBI is recognized by government and private funding agencies, research can be directed at discovering therapies that may interrupt the disease processes months or even years after the initiating event.
Previous studies suggest that a greater proportion of neck injury patients, whose injuries were sustained through whiplash accidents, become chronic due to a component of sickness-focusing. However, ...it is also possible that some of those with neck injuries were already more frail prior to the injury, resulting in more consequences from a certain intensity of injury. The objective of this study was to compare co-morbidity and mortality in people with a registered neck injury diagnosis, evaluated prior to and after the neck injury, to people without a registered neck injury evaluated at the same time-points.
From a hospital patient registry over a 12-year period, we identified those with the diagnosis 'cervical-column distortion' and matched four controls for each of them on sex, age, marital status and county of residence. For calculations of co-morbidity, those with an injury at year 1, who thus had no prior data, and for those at year 12 who did not have post data, were not included. The same applied to their individually matched controls. Health data for up to 3 years prior to and up to 3 years after the year of injury were recorded.
We identified 94,224 cases and 373,341 controls. Those with registered neck injuries had 1.2-2.0 times more co-morbidities than controls after the injury, but had already had about the same (1.3-1.8 more co-morbidities) number of co-morbidities prior to the injury. Mortality up to 12 years was approximately the same in the two groups.
Those people having a registered neck injury had more co-morbidity diagnoses both before and after the injury than those without a registered neck injury. This suggests that the co-morbidities observed after the injury may be partly related to already existing general high health care-seeking and/or a low health status, rather than being entirely the consequence of the injury.
Background-Administrative data from medical claims are often used for injury surveillance. Effective October 1, 2015, hospitals covered by the Health Insurance Portability and Accountability Act were ...required to use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to report medical information in administrative data. In 2017, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed ICD-10-CM surveillance case definition for injuryrelated emergency department (ED) visits. At the time, ICD-10-CM coded data were not available for testing. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and epidemiologists from state and local health departments to test and update the proposed definition. This report summarizes the results and presents the 2021 revised ICD-10-CM surveillance case definition.
Background: Hospital discharge data (HDD) represent one of the most valuable information sources for injury prevention and control. Objectives: To investigate external code of injury (E-code) ...underreporting in the Finnish National Hospita Discharge Register from 1 January 1987 to 31 December 2004. Material and methods: HDD for discharges with an injury as the main diagnosis were extracted from the FNHDR. The selection was made using codes for nature of injury (1987-1995, ICD-9; 1996-2004, ICD-10). The proportion of injury discharges with a missing E-code was examined by sex, age, hospital districts, type of hospital, duration of hospitalization, and nature of injury. Results: In 432,549 (23.1%) of the recorded 1,868,519 discharges, an E-code was missing. The proportion of the discharges with a missing E-code varied among the above variables. During the period 1987-2004, the overall E-code underreporting decreased from 18.0% to 12.8%. The introduction of the ICD-10 in 1996 was followed by a dramatic increase (up to 57.5% of all discharges) in E-code underreporting. Conclusions: More attention ought to be dedicated to teaching and periodic training on the use of E-codes. Educational activities should specifically target the medical doctors, who, in Finland, are responsible for assigning the E-codes.
To determine the relationship between socioeconomic level (measured through individual educational level and material deprivation in the areas of residence) and injury morbidity in different age ...groups and in males as well as in females.
Cross-sectional survey.
Barcelona (Spain).
The study population included all cases over the age of 19 who, as a result of an injury (motor vehicles injuries, falls, hits and cuts), were admitted to the emergency departments of the six main hospitals of the city during the years 1990–1991. Age- and sex-specific morbidity rates were calculated for each educational level and each cause of injury. The contextual variable included was the proportion of unemployment in each neighbourhood. Multilevel Poisson regression models were fitted.
Morbidity rates were higher in males, in young people and for lower educational levels. Results from the multilevel models show that, at contextual level, neighbourhoods with more unemployment present a higher risk of injuries. At individual level, after adjusting for contextual variables, the risk of sustaining injuries was higher among young men and women for all injury causes except falls among women where the risk was higher in the elderly; among both men and women, the risk of sustaining injury was higher in the population with lower educational level (RR = 1.79, 95% CI = 1.73–1.86 in men; RR = 2.12, 95% CI = 2.04–2.21 in women). This trend was also observed separately for traffic injuries, falls, hits and cuts.
Our results provide information about individual and contextual social inequalities in injury morbidity, the highest risks of injury occur in individuals of lower educational level and who reside in the more privated neighbourhoods. These results underscore the need to implement injury prevention strategies not only at the individual level, but also to tailor them to the socioeconomic position of the population.
Using the 1988 and 1989 National Health Interview Surveys, we explore the hypothesis that injury-related morbidity in general follows the same patterns of association with social/economic ...circumstances as has been found for injury-related mortality. We find the relationship to sociodemographic factors is similar to injury mortality. Also, being married appears to offer some protection against the risk of injury morbidity. Socioeconomic factors indicate that, controlling for poverty, whites of all ages are more likely to report a nonfatal injury. Finally, the net effects of other living circumstances and level of education have no significant effect on the risk of nonfatal injury. We discuss several explanations: problems of defining reportable morbidity; differential access to medical care; and the need to understand injury cause and severity to better explore the structural correlates of injury morbidity.
The current study concerns socioeconomic differences in the risk of non-fatal injuries related to different types of products, and considers male and female at various ages. Data were taken from a ...community-based injury register built up over one year (November 1989 to October 1990) in a semi-urban Swedish municipality (256,510 inhabitants), and then linked by record to Sweden's National Population Register (based on the census of 1990). Injuries related to manufactured products among the age group 0–64 were considered (8969 cases). Odds ratios were computed by gender for five categories of products and four socioeconomic groups (using salaried employees as the reference group). Compared with salaried employees, people from less advantaged socioeconomic groups (i.e. members of the unspecified population and manual workers) tended to record significantly higher injury morbidity related to all categories of products except sports and recreational equipment. Differences between groups were particularly pronounced among males, but were still evident among females. Contrary to expectation, in the younger age group (0–14 years), differences between socioeconomic groups were found for only two product categories: vehicles, for the unspecified population, and domestic appliances, food and drink, among manual workers). The results show that some kinds of products are determinant of differences in injury risks between socioeconomic groups, and that their role may change with age. It is suggested that progress in combating socioeconomic differences in safety could be made by defining targets for prevention with regard to commonplace aspects of everyday life.
Using the method described in Part I (p. 283), data on the epidemiology of traumatic brain injury (TBI) in Johannesburg are presented. The overall annual incidence of TBI is 316 per 100,000. Data for ...Africans and Whites show marked contrasts. Among Africans, incidence is 355/100,000, with a male-female ratio of 4.4, and 763/100,000 for males aged 25-44; for Whites, it is 109/100,000 overall, with a male-female ratio of 40.1, and 419/100,000 for men aged 15-24. The overall incidence of fatal TBI is 80/100,000, with a case fatality ratio of 0.20. Interpersonal violence accounts for 51% of nonfatal TBI among Africans, as against 10% for Whites, while motor vehicle accidents cause 27% of African nonfatal TBI and 63% among Whites. Some explanatory hypotheses for this race- and sex-specific skewing of the incidence and causes of TBI are developed.
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