scholarly journals Analyzing Mortality Risk and Medical Burden among Patients with Traumatic Brain Injury and Subsequent Dementia

2019 ◽  
Vol 8 (5) ◽  
pp. 686
Author(s):  
Dorji Harnod ◽  
Tomor Harnod ◽  
Cheng-Li Lin ◽  
Chia-Hung Kao
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Risk ◽  
International Classification Of Diseases ◽  
Research Database ◽  
Medical Visits ◽  
Classification Of Diseases ◽  
The Government ◽  
Medical Burden ◽  
Hospital Days

We used the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic dementia (PTD) exhibit increased mortality and medical burden than those without it. Patients ≥20 years of age having head injury admission (per the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854, 959.01) between 2000 and 2012 were enrolled as traumatic brain injury (TBI) cohort. A PTD cohort (with ICD-9-CM codes 290, 294.1, 331.0) and a posttraumatic nondementia (PTN) cohort were established and compared in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk, number of hospital days, and frequency of medical visits in these cohorts. Patients with PTD had a higher mortality rate than did patients with TBI alone (rate per 1000 person-years: 12.00 vs. 6.32), with an aHR of 1.54 (95% CI: 1.32–1.80). Patients with PTD who were aged ≥65 years (aHR = 1.54, 95% CI: 1.31–1.80) or male (aHR = 1.78, 95% CI: 1.45–2.18) exhibited greatly increased risks of mortality. Furthermore, patients with PTD had 19.9 more hospital days and required medical visits 4.49 times more frequently compared with the PTN cohort. Taiwanese patients with PTD had increased mortality risk and medical burden compared with patients who had TBI only. Our findings provide crucial information for clinicians and the government to improve TBI and PTD outcomes.

scholarly journals Mortality Risk and Risk Factors in Patients with Posttraumatic Epilepsy: A Population-Based Cohort Study

2019 ◽  
Vol 16 (4) ◽  
pp. 589 ◽  
Author(s):  
Wei-Jun Lin ◽  
Tomor Harnod ◽  
Cheng-Li Lin ◽  
Chia-Hung Kao
Keyword(s):  
Mortality Risk ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Research Database ◽  
Posttraumatic Epilepsy ◽  
Medical Visits ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
The Government

Aim: Use the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic epilepsy (PTE) have an increased risk of mortality. Methods: Patients ≥20 years old ever admitted because of head injury (per International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854 and 959.01) during 2000–2012 were enrolled into a traumatic brain injury (TBI) cohort. The TBI cohort was divided into with PTE (ICD-9-CM code 345) and posttraumatic nonepilepsy (PTN) cohorts. We compared the PTE and PTN cohorts in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts. Results: Patients with PTE had a higher incidence rate (IR) of mortality than did patients with TBI alone (IR per 1000 person-years: 71.8 vs. 27.6), with an aHR 2.31 (95% CI = 1.96–2.73). Patients with PTE aged 20–49, 50–64, and ≥65 years had, respectively, 2.78, 4.14, and 2.48 times the mortality risk of the PTN cohort. Patients with any comorbidity and PTE had 2.71 times the mortality risk as patients in the PTN cohort. Furthermore, patients with PTE had 28.2 increased hospital days and 7.85 times as frequent medical visits per year compared with the PTN cohort. Conclusion: Taiwanese patients with PTE had approximately 2 times the mortality risk and an increased medical burden compared to patients with TBI only. Our findings provide crucial information for clinicians and the government to improve TBI outcomes.

scholarly journals Long-Term Mortality and Medical Burden of Patients with Chronic Obstructive Pulmonary Disease with and without Subsequent Stroke Episodes

2020 ◽  
Vol 17 (7) ◽  
pp. 2550
Author(s):  
Yu-Shu Yen ◽  
Dorji Harnod ◽  
Cheng-Li Lin ◽  
Tomor Harnod ◽  
Chia-Hung Kao
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Mortality Risk ◽  
Fold Increase ◽  
International Classification Of Diseases ◽  
Chronic Obstructive ◽  
Research Database ◽  
Obstructive Pulmonary Disease ◽  
Medical Visits ◽  
Medical Burden

Background: We used the Taiwan National Health Insurance Research Database (NHIRD) to determine the differences in mortality and medical burden between patients with chronic obstructive pulmonary disease (COPD) with and without stroke. Methods: We enrolled participants aged ≥20 years and defined four subgroups in this study, namely patients with COPD (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM): 491, 492, 494, and 496), patients with COPD with stroke (ICD-9 CM: 430–438), with COPD without stroke, and comparison subgroups. We calculated the hazard ratios and 95% CIs for all-cause mortality risk, average duration of hospitalization, and frequency of medical visits in these subgroups after adjustments were made for age, sex, and comorbidities. All participants were followed until the date of death, the date they were censored, the date they withdrew from the NHIRD, or 31 December, 2013. Results: In total, 9.70% (men vs. women, 11.19% vs. 8.28%) of patients with COPD developed subsequent stroke during the 14 year follow-up. After a stroke, the risk of mortality exhibited a 2.66- to 5.05-fold increase, especially in the younger ones. COPD with stroke was also a leading factor in the increase in the average number of hospitalization days and frequency of medical visits. Conclusion: The mortality risk of patients with COPD is considerably increased by stroke independent of the other effects of COPD. Moreover, the average number of hospitalization days and frequency of medical visits dramatically increased in patients with COPD after stroke.

scholarly journals Reduced Use of Emergency Care and Hospitalization in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Chun-Chuan Shih ◽  
Hsun-Hua Lee ◽  
Ta-Liang Chen ◽  
Chin-Chuan Tsai ◽  
Hsin-Long Lane ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Emergency Care ◽  
Acupuncture Treatment ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
First Year ◽  
Research Database ◽  
Medical Visits ◽  
Relative Risks

Background. Little research exists on acupuncture treatment’s effect on patients with traumatic brain injury (TBI).Methods. Using Taiwan’s National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs) and 95% confidence intervals (CIs) of high use of emergency care and hospitalization associated with acupuncture treatment were calculated in multivariate Poisson regression models with generalized estimating equation.Results. The means of medical visits of emergency care and hospitalization were lower in TBI patients with acupuncture treatment than in those without acupuncture treatment. After adjustment, acupuncture treatment was associated with decreased risk of high emergency care visits (beta = −0.0611,P=0.0452) and hospitalization (beta = −0.0989,P<0.0001). The RRs of high medical visits and expenditure for hospitalization associated with acupuncture treatment were 0.62 (95% CI = 0.50–0.76) and 0.66 (95% CI = 0.53–0.83), respectively.Conclusion. Patients with TBI who receive acupuncture treatment have reduced the use of emergency care and hospitalization in the first year after injury. The mechanisms of effects of acupuncture on TBI warrant further investigations.

scholarly journals Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study

2018 ◽  
Vol 7 (10) ◽  
pp. 366 ◽  
Author(s):  
Tomor Harnod ◽  
Weishan Chen ◽  
Jen-Hung Wang ◽  
Shinn-Zong Lin ◽  
Dah-Ching Ding
Keyword(s):  
International Classification Of Diseases ◽  
Population Based ◽  
Research Database ◽  
Predisposing Factor ◽  
Post Surgery ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
Hormone Use ◽  
The Government

Using the National Health Insurance Research Database of Taiwan, we investigated whether undergoing a hysterectomy increases the risk of depression. A total of 7872 patients aged 30–49 years who underwent a hysterectomy from 2000 to 2013 were enrolled as the hysterectomy group. The comparison group was randomly selected from women who had never undergone a hysterectomy and was four times the size of the hysterectomy group. We calculated adjusted hazard ratios and 95% confidence intervals (CIs) for depression [The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 296.2, 296.3, 300.4, 311] in these cohorts after adjusting for age, comorbidities, oophorectomy, and hormone therapy. The overall incidence of depression was 1.02 and 0.66 per 100 person-years in the hysterectomy and comparison cohorts, respectively, yielding an adjusted hazard ratio of 1.35 (95% CI = 1.22–1.50) for depression risk. When we stratified patients by age, comorbidities, oophorectomy, and hormone use, hysterectomy increased the risk of depression. Hysterectomy, oophorectomy, and post-surgery hormone use were associated with an increased risk of depression when they occurred alone, but conferred a greater risk if they were considered jointly. Hysterectomy would be a predisposing factor for increased risk of subsequent depression. Our findings provide vital information for patients, clinicians, and the government for improving the treatment strategy in the future.

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.

scholarly journals Geographic Disparities in Mortality Risk Within a Racially Diverse Sample of U.S. Veterans with Traumatic Brain Injury

Health Equity ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 304-312
Author(s):  
Clara E. Dismuke-Greer ◽  
Mulugeta Gebregziabher ◽  
Tiarney Ritchwood ◽  
Mary Jo Pugh ◽  
Rebekah J. Walker ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Risk ◽  
Racially Diverse ◽  
Geographic Disparities

scholarly journals Patient Outcomes following Subarachnoid Hemorrhage between the Medical Center and Regional Hospital: Whether All Patients Should Be Transferred to Medical Centers

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Tsung-Ying Lin ◽  
Chieh Hsin Wu ◽  
Wei-Che Lee ◽  
Chao-Wen Chen ◽  
Liang-Chi Kuo ◽  
...  
Keyword(s):  
Health Insurance ◽  
Subarachnoid Hemorrhage ◽  
Hospital Volume ◽  
Medical Center ◽  
International Classification Of Diseases ◽  
Research Database ◽  
Medical Centers ◽  
Classification Of Diseases ◽  
Comorbidity Index

Subarachnoid hemorrhage (SAH) is a critical illness that may result in patient mortality or morbidity. In this study, we investigated the outcomes of patients treated in medical center and nonmedical center hospitals and the relationship between such outcomes and hospital and surgeon volume. Patient data were abstracted from the National Health Insurance Research Database of Taiwan in the Longitudinal Health Insurance Database 2000, which contains all claims data of 1 million beneficiaries randomly selected in 2000. The International Classification of Diseases, Ninth Revision, subarachnoid hemorrhage (430) was used for the inclusion criteria. We identified 355 patients between 11 and 87 years of age who had subarachnoid hemorrhage. Among them, 32.4% (115/355) were men. The median Charlson comorbidity index (CCI) score was 1.3 (SD ± 0.6). Unadjusted logistic regression analysis demonstrated that low mortality was associated with high hospital volume (OR = 3.21; 95% CI: 1.18–8.77). In this study, we found no statistical significances of mortality, LOS, and total charges between medical centers and nonmedical center hospitals. Patient mortality was associated with hospital volume. Nonmedical center hospitals could achieve resource use and outcomes similar to those of medical centers with sufficient volume.

scholarly journals Association between suicide risk and traumatic brain injury in adults: a population based cohort study

2020 ◽  
pp. postgradmedj-2019-136860 ◽  
Author(s):  
Yueh-Chien Lu ◽  
Ming-Kung Wu ◽  
Li Zhang ◽  
Cong-Liang Zhang ◽  
Ying-Yi Lu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cause Of Death ◽  
Suicide Risk ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Population Based ◽  
Research Database ◽  
Global Public Health

BackgroundTraumatic brain injury (TBI) is a major cause of death and disability worldwide, and its treatment is potentially a heavy economic burden. Suicide is another global public health problem and the second leading cause of death in young adults. Patients with TBI are known to have higher than normal rates of non-fatal deliberate self-harm, suicide and all-cause mortality. The aim of this study was to explore the association between TBI and suicide risk in a Chinese cohort.MethodThis study analysed data contained in the Taiwan National Health Insurance Research Database for 17 504 subjects with TBI and for 70 016 subjects without TBI matched for age and gender at a ratio of 1 to 4. Cox proportional hazard regression analysis was used to estimate subsequent suicide attempts in the TBI group. Probability of attempted suicide was determined by Kaplan-Meier method.ResultsThe overall risk of suicide attempts was 2.23 times higher in the TBI group compared with the non-TBI group (0.98 vs 0.29 per 1000 person-years, respectively) after adjustment for covariates. Regardless of gender, age or comorbidity, the TBI group tended to have more suicide attempts, and the risk attempted suicide increased with the severity of TBI. Depression and alcohol attributed disease also increased the risk of attempted suicide in the TBI group.ConclusionSuicide is preventable if risk factors are recognised. Hence, TBI patients require special attention to minimise their risk of attempted suicide.

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