scholarly journals Health & Economic Burden of Traumatic Brain Injury in the Emergency Department

2016 ◽  
Vol 43 (2) ◽  
pp. 238-247 ◽  
Author(s):  
Terence S. Fu ◽  
Rowan Jing ◽  
Steven R. McFaull ◽  
Michael D. Cusimano
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Economic Burden ◽  
Motor Vehicle ◽  
Lifetime Cost ◽  
Productivity Loss ◽  
Significant Proportion ◽  
The Elderly ◽  
Lifetime Costs

AbstractObjective:To evaluate epidemiological patterns and lifetime costs of traumatic brain injury (TBI) identified in the emergency department (ED) within a publicly insured population in Ontario, Canada, in 2009.Methods:A nationally representative, population-based database was used to identify TBI cases presenting to Ontario EDs between April 2009 and March 2010. We calculated unit costs for medical treatment and productivity loss, and multiplied these by corresponding incidence estimates to determine the lifetime costs of identified TBI cases across age group, sex, and mechanism of injury.Results:In 2009, there were more than 133,000 ED visits for TBI in Ontario, resulting in a conservative estimate of $945 million in lifetime costs. Lifetime cost estimates ranged from $279 million to $1.22 billion depending on the diagnostic criteria used to define TBI. Peak rates of TBI occurred among young children (ages 0-4 year) and the elderly (ages 85+ years). Males experienced a 53% greater rate of TBI and incurred two-fold higher costs compared with females. Falls, sports/bicyclist-related injuries, and motor vehicle crashes represented 47%, 12%, and 10% of TBI presenting to ED, respectively, and accounted for a significant proportion of costs.Conclusions:This study revealed an enormous health and economic burden associated with TBI identified in the ED setting. Our findings underscore the importance of ongoing surveillance and prevention efforts targeted to vulnerable populations. More research is needed to fully appreciate the burden of TBI across a variety of health care settings.

scholarly journals Lifetime costs of traumatic brain injury identified in the emergency department in Ontario

2015 ◽  
Vol 42 (S1) ◽  
pp. S39-S39
Author(s):  
T Fu ◽  
R Jing ◽  
M Cusimano
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Economic Burden ◽  
Motor Vehicle ◽  
Productivity Loss ◽  
Age Groups ◽  
Population Based ◽  
Lifetime Costs ◽  
Ed Visits

Background: Traumatic brain injury (TBI) is a leading cause of death and disability, yet there is limited research on its economic burden. We estimated the incidence and lifetime costs of TBI identified in the Emergency Department (ED) in Ontario, Canada between April 2009 and March 2010. Methods: ED visits for TBI were identified using a population-based database that is mandatory for ambulatory care facilities in Ontario. The authors calculated unit costs for medical treatment and productivity loss, and multiplied these by incidence estimates to determine the lifetime costs of identified TBI cases. Results: In 2009, there were over 133,000 ED visits for TBI in Ontario, resulting in a conservative estimate of $945 million in total lifetime costs. Costs were greater for males than females across nearly all age groups, with males incurring two-fold higher costs overall. Together, falls ($407 million), struck by/against ($309 million), and motor vehicle injuries ($161 million) represented 93% of lifetime costs associated with TBI. Conclusions: This study revealed a high incidence and economic burden associated with TBI identified in the ED. More research is needed to fully appreciate the burden of TBI across a variety of healthcare settings.

scholarly journals Epidemiological patterns of traumatic brain injury identified in the emergency department in Ontario, 2002-2010

2015 ◽  
Vol 42 (S1) ◽  
pp. S39-S39
Author(s):  
T Fu ◽  
R Jing ◽  
M Cusimano
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Young Children ◽  
Motor Vehicle ◽  
Population Based ◽  
Incidence Rates ◽  
Elderly Adults ◽  
Ed Visits ◽  
Group Sex

Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability, and most TBIs are treated in the Emergency Department (ED). We examined the incidence and epidemiological patterns of TBIs presenting to Ontario EDs over an eight-year period. Methods: All TBI-related ED visits between April 2002 and March 2010 were identified using a population-based database that is mandatory for ambulatory care facilities in Ontario. Incidence rates were reported across multiple strata, including age group, sex, and mechanism of injury. Results: From 2002-2010, there were 1,032,249 ED visits for TBI in Ontario. Peak rates occurred among young children ages 0-4 (349 per 10,000) and elderly adults ages 85+ (243 per 10,000). Overall, males experienced a 53% greater rate of TBI compared to females. Falls (47%), motor vehicle crashes (MVC; 10%), and sports-related injuries (9%) were the most common causes of TBI. The highest rates of TBI-related falls, MVCs, and sports-related injuries occurred among young children (0-4) and elderly adults (85+), adolescents/young adults (15-24), and children (5-14), respectively. Conclusions: Our study reveals a substantial health system burden associated with TBI in the ED setting, underscoring the need for enhanced surveillance and prevention efforts targeted to vulnerable demographic groups.

scholarly journals A Predictive Model to Analyze the Factors Affecting the Presence of Traumatic Brain Injury in the Elderly Occupants of Motor Vehicle Crashes Based on Korean In-Depth Accident Study (KIDAS) Database

2021 ◽  
Vol 18 (8) ◽  
pp. 3975
Author(s):  
Hee Young Lee ◽  
Hyun Youk ◽  
Oh Hyun Kim ◽  
Chan Young Kang ◽  
Joon Seok Kong ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Brain Injury ◽  
Predictive Model ◽  
Motor Vehicle ◽  
The Elderly ◽  
Motor Vehicle Crashes ◽  
Vehicle Crashes ◽  
Factors Affecting

Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force injures the brain. This study aimed to analyze the factors affecting the presence of TBI in the elderly occupants of motor vehicle crashes. We defined elderly occupants as those more than 55 years old. Damage to the vehicle was presented using the Collision Deformation Classification (CDC) code by evaluation of photos of the damaged vehicle, and a trauma score was used for evaluation of the severity of the patient’s injury. A logistic regression model was used to identify factors affecting TBI in elderly occupants and a predictive model was constructed. We performed this study retrospectively and gathered all the data under the Korean In-Depth Accident Study (KIDAS) investigation system. Among 3697 patients who visited the emergency room in the regional emergency medical center due to motor vehicle crashes from 2011 to 2018, we analyzed the data of 822 elderly occupants, which were divided into two groups: the TBI patients (N = 357) and the non-TBI patients (N = 465). According to multiple logistic regression analysis, the probabilities of TBI in the elderly caused by rear-end (OR = 1.833) and multiple collisions (OR = 1.897) were higher than in frontal collision. Furthermore, the probability of TBI in the elderly was 1.677 times higher in those with unfastened seatbelts compared to those with fastened seatbelts (OR = 1.677). This study was meaningful in that it incorporated several indicators that affected the occurrence of the TBI in the elderly occupants. In addition, it was performed to determine the probability of TBI according to sex, vehicle type, seating position, seatbelt status, collision type, and crush extent using logistic regression analysis. In order to derive more precise predictive models, it would be needed to analyze more factors for vehicle damage, environment, and occupant injury in future studies.

Incidence of Neck Pain in Pediatric Mild Traumatic Brain Injury in the Emergency Department

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S10.3-S11
Author(s):  
Brieana Hope Rodriguez ◽  
Danny Thomas
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Neck Pain ◽  
Mild Traumatic Brain Injury ◽  
Motor Vehicle ◽  
Pediatric Population ◽  
Motor Vehicle Accidents ◽  
Vehicle Accidents

ObjectiveTo determine (1) the frequency of reported cervical spine pain in patients diagnosed with mild traumatic brain injury (mTBI) in the Children's Hospital of Wisconsin emergency department (ED), and (2) the predictors of number of follow up visits for concussion related symptoms between those with and without neck pain.BackgroundThere has been little research on the frequency of concomitant injury, specifically neck pain associated with TBI in the pediatric population. Given the potential influence of neck pain on recovery from mTBI, we sought to report on the frequency of reported neck pain in the sample of pediatric ED patients reporting mTBI symptoms.Design/MethodsThe sample was obtained through a retrospective analysis in the setting of Children's Hospital of Wisconsin Emergency Department with a subject selection of patients diagnosed with a concussion/mTBI between the dates of 11/1/2015–06/30/2018.ResultsWe analyzed 652 charts. The frequency of reported neck pain in the pediatric population being evaluated for mTBI in the ED was 13.8%. Of these patients, 32.2% had subsequent follow up visits related to their concussion/neck pain compared to 31.1% in patients without neck pain in the ED. In regards to the TBI cause, 47.8% were due to accidental falls, 40.3% were due to other accidents not related to motor vehicles, and 10.0% were due to motor vehicle accidents.ConclusionsIn comparison to the adult mTBI population, the pediatric mTBI population had a significantly less reported frequency of neck pain in the ED. This is not surprising as the majority of adults presenting for concussions and neck pain are post-motor vehicle accidents, whereas the majority of children are presenting after accidental falls. There did not seem to be an association between concussions with concomitant neck pain and prolonged recovery or increased morbidity as determined by follow up visits.

Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

2020 ◽  
pp. 1-10
Author(s):  
Brittany M. Stopa ◽  
Maya Harary ◽  
Ray Jhun ◽  
Arun Job ◽  
Saef Izzy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Data Bank ◽  
The United States ◽  
National Sample ◽  
Population Based ◽  
Weighted Estimates ◽  
True Incidence ◽  
Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

scholarly journals Multisite medical record review of emergency department visits for traumatic brain injury

2021 ◽  
Vol 27 (S1) ◽  
pp. i42-i48
Author(s):  
Barbara A Gabella ◽  
Jeanne E Hathaway ◽  
Beth Hume ◽  
Jewell Johnson ◽  
Julia F Costich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Skull Fracture ◽  
Signs And Symptoms ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Intracranial Injury ◽  
Imaging Results ◽  
Icd 10

BackgroundIn 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.MethodsFour study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).ResultsPPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.DiscussionICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients

2020 ◽  
pp. 1-7
Author(s):  
Callum J. Prosser ◽  
David Edwards ◽  
Omar Boumara ◽  
Gordon Fuller ◽  
Damian Holliman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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