Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada

Abstract

Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide. We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2011 using a nationwide, population-based database that is mandatory for all hospitals in Canada. Methods: Trends in hospitalization rates for all acute hospital separations in Canada were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. Results: Hospitalization rates remained stable for children and young adults, but increased considerably among elderly adults (ages 65 and older). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p=0.01), while MVC-related hospitalization rates decreased by 18% (p=0.03). Elderly adults were most vulnerable to falls, and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages 15-24) were most at risk for MVCs, but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends towards increasing age, injury severity, comorbidity, hospital length of stay, and rate of in-hospital mortality. However, multivariate regression showed that odds of death decreased over time after controlling for relevant factors. Injury severity, comorbidity, and advanced age were the most important predictors of in-hospital mortality for TBI inpatients. Conclusions: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities. Although preventive strategies for MVC-related TBI are likely having some effects, there is a critical need for effective fall prevention strategies, especially among elderly adults.

The Impact of Medical Complications in Predicting the Rehabilitation Outcome of Patients With Disorders of Consciousness After Severe Traumatic Brain Injury

“…Mathias and Wheaton (2015) demonstrated that elderly patients have less brain reserve and greater vulnerability that amplify brain damage and limit functional recovery. Moreover, Fu et al (2015) found that the severity of lesions, the number of MCs, and older age are the most important predictors of intra-hospital mortality in these patients. Again, other clinical factors could unpredictably influence patients' clinical evolution, such as the presence of ischemic or organic heart diseases (Pistoia et al, 2015) or altered brain activity (Sarà et al, 2011).…”

“…One of the main nuisance factors affecting functional recovery from severe TBI is the presence of medical complications (MCs; Ganesh et al, 2013;Whyte et al, 2013;Pistoia et al, 2015). The presence of one or more MCs is associated with increased hospitalization time, worsened functional outcome, and increased mortality (Fu et al, 2015;Chan et al, 2017). Generally, these disorders are directly related to paroxysmal sympathetic hyperactivity (Lucca et al, 2019) or epileptic seizures (Pascarella et al, 2016).…”

Changing Epidemiological Patterns in Traumatic Brain Injury: A Longitudinal Hospital-Based Study in Belgium

“…In Canada, Fu et al [22] reported stable hospital admission rates for children and young adults over the period 2006-2010 but did report an increase of TBI in elderly adults. In the United States, Coronado et al [3] reported an increase in the number of emergency department and outpatient department visits, but no change in hospital admission rates over the period 1995-2009.…”

Quality of life measures in older adults after traumatic brain injury: a systematic review

“…The rate of hospitalization among older adults (≥ 65 years of age) with traumatic brain injury (TBI) has increased by 24% over the past decade [1]. On average, older adults with TBI are hospitalized four times as often, have longer hospital stays [2], and experience slower recovery trajectories and worse functional outcomes compared to younger populations with the same injury severity after TBI [3].…”