Hospitalizations and Emergency Department Visits for TBI in Ontario

Abstract

Traumatic brain injury (TBI) is one of the leading causes of death and disability in North America and as such requires ongoing surveillance 1,2 . Tracking health resource utilization over time, by age, and by gender provides valuable information regarding the burden of TBI on health care services, including post acute care. Furthermore, accurately identifying the rates of TBI is critical to the planning and evaluation of prevention efforts.Recent reports based on hospital admission data in Canada and the United States have documented a decrease in the number of in-patient admissions over the last two decades 3,4 , particularly for children and for incidents of "mild" TBI (mTBI). Studies that focus on in-patient admissions, however, may be misleading in that the decrease in numbers could reflect a shift towards treating children and mTBI sufferers at emergency departments (EDs). To date, there are no recent peer reviewed studies documenting TBI-related ED visits at a population based level, in a publicly ABSTRACT: Objective: The aim of this study was to determine the number of annual hospitalizations and overall episodes of care that involve a traumatic brain injury (TBI) by age and gender in the province of Ontario. To provide a more accurate assessment of the prevalence of TBI, episodes of care included visits to the emergency department (ED), as well as admissions to hospital. Mechanisms of injury for overall episodes were also investigated. Methods: Traumatic brain injury cases from fiscal years 2002/03-2006/07 were identified by means of ICD-10 codes. Data were collected from the National Ambulatory Care Reporting System and the Discharge Abstract Database. Results: The rate of hospitalization was highest for elderly persons over 75 years-of-age. Males generally had higher rates for both hospitalizations and episodes of care than did females. The inclusion of ED visits to hospitalizations had the greatest impact on the rates of TBI in the youngest age groups. Episodes of care for TBI were greatest in youth under the age of 14 and elderly over the age of 85. Falls (41.6%) and being struck by or against an object (31.1%) were the most frequent causes for a TBI. Conclusions:The study provides estimates for TBI from the only Canadian province that has systematically captured ED visits in a national registry. It shows the importance of tracking ED visits, in addition to hospitalizations, to capture the burden of TBI on the health care system. Prevention strategies should include information on ED visits, particularly for those at younger ages. Cette étude fournit des estimés de LCT dans la seule province canadienne qui inscrit a systématiquement les visites à l'urgence dans un registre nationale. Elle montre l'importance de faire le suivi des visites à l'urgence en plus des hospitalisations pour apprécier le fardeau que constitue la LCT sur le système de santé. Les stratégies de prévention devraient mentionner l'information sur les visites à l'urgence, particulièrement chez les jeunes.

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury

“…Individuals with intentional injuries are more likely to be male, non-Caucasian, single, and unemployed, and have lower levels of educational attainment, higher rates of intoxication, and a history of criminal behavior. [47][48][49][50] The connection between common factors of assault-related TBI and PTSD warrants further investigation, and in larger populations with more diverse demographic characteristics, location of medical care, and racial subgroups for validation.…”

Brain Injury is a Major Problem in Canada and Annual Incidence is Not Declining

“…The Colantonio et al report also confirms some important demographic data about TBI patients, especially the overall preponderance of males in terms of number of cases per year, especially young males in the up to 24-year-old age group 5 . Indeed, it was astounding that more than half the cases of TBI in males and slightly less than half the cases in females were 24 or less.…”

“…Indeed, the 2007 CIHI report generated a ThinkFirst Canada symposium on TBI incidence at which declining hospitalization for TBI was thought primarily due to significant practice changes 8 . The report by Colantonio and colleagues confirms that the annual incidence of TBI is not declining 5 .…”

“…The Colantonio et al report is also noteworthy because it describes the mechanisms and causes of injury more accurately than other TBI reports 5 . Typical reports of this type use broad categories such as "motor vehicle accidents" that include diverse activities such as cars and trucks on highways and snowmobiles and ATVs on trails, and "falls" that include diverse events such as a construction worker falling off a 40-storey building, a 95-year-old falling downstairs at home, and a child falling off a trampoline.…”

“…Even with the above limitations most of which were acknowledged by the authors, their combined data on hospitalizations and ED visits provide much useful information 5 . For example, they showed clearly that three times as many TBI patients visit EDs than get admitted to hospitals, and that the total number of TBIs did not decrease during the 2002-2007 period of their study.…”