scholarly journals Geographical disparity and traumatic brain injury in America: Rural areas suffer poorer outcomes

2019 ◽  
Vol 10 (01) ◽  
pp. 10-15 ◽  
Author(s):  
Joshua B Brown ◽  
Marin Kheng ◽  
Nancy A Carney ◽  
Andres A Rubiano ◽  
Juan Carlos Puyana
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Rural Areas ◽  
The United States ◽  
Significant Heterogeneity ◽  
County Level ◽  
Fatality Rate ◽  
Mortality And Morbidity ◽  
Metropolitan Counties

ABSTRACTIntroduction: Significant heterogeneity exists in traumatic brain injury (TBI) outcomes. In the United States, TBI remains a primary driver of injury-related mortality and morbidity. Prior work has suggested that disparity exists in rural areas; our objective was to evaluate potential differences in TBI mortality across urban and rural areas on a national scale. Methods: Age-adjusted TBI fatality rates were obtained at the county level across the U.S. from 2008 to 2014. To evaluate geography, urban influence codes (UIC) were also obtained at the county level. UIC codes range from 1 (most urban) to 12 (most rural). Metropolitan counties are defined as those with an UIC ≤2, while nonmetropolitan counties are defined as an UIC ≥3. County-level fatality rates and UIC classification were geospatially mapped. Linear regression was used to evaluate the change in TBI fatality rate at each category of UIC. The median TBI fatality rate was also compared between metropolitan and nonmetropolitan counties. Results: Geospatial analysis demonstrated higher fatality rates distributed among nonmetropolitan counties across the United States. The TBI fatality rate was 13.00 deaths per 100,000 persons higher in the most rural UIC category compared to the most urban UIC category (95% confidence interval 12.15, 13.86; P < 0.001). The median TBI rate for nonmetropolitan counties was significantly higher than metropolitan counties (22.32 vs. 18.22 deaths per 100,000 persons, P < 0.001). Conclusions: TBI fatality rates are higher in rural areas of the United States. Additional studies to evaluate the mechanisms and solutions to this disparity are warranted and may have implications for lower-and middle-income countries.

scholarly journals Adult sports-related traumatic brain injury in United States trauma centers

2016 ◽  
Vol 40 (4) ◽  
pp. E4 ◽  
Author(s):  
Ethan A. Winkler ◽  
John K. Yue ◽  
John F. Burke ◽  
Andrew K. Chan ◽  
Sanjay S. Dhall ◽  
...  
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Health Concern ◽  
Medical Complications ◽  
Equestrian Sports ◽  
Prolonged Hospital

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories—fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CONCLUSIONS Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use—particularly in equestrian and roller sports—are critical elements for decreasing sports-related TBI events in adults.

Traumatic Brain Injury and Psychiatric Co-Morbidity in the United States

2018 ◽  
Vol 90 (1) ◽  
pp. 151-158 ◽  
Author(s):  
Michael G. Vaughn ◽  
Christopher P. Salas-Wright ◽  
Rachel John ◽  
Katherine J. Holzer ◽  
Zhengmin Qian ◽  
...  
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The United States ◽  
Co Morbidity

Costs of Nonfatal Traumatic Brain Injury in the United States, 2016

Medical Care ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Gabrielle F. Miller ◽  
Lara DePadilla ◽  
Likang Xu
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The United States

scholarly journals Association of traumatic brain injury with dementia and memory decline in older adults in the United States

2020 ◽  
Vol 16 (6) ◽  
pp. 853-861
Author(s):  
Leslie Grasset ◽  
M. Maria Glymour ◽  
Kristine Yaffe ◽  
Samuel L. Swift ◽  
Kan Z. Gianattasio ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The United States ◽  
Memory Decline

Waterjet Assisted Craniotome for Reduced Dural Tears

2018 ◽  
Author(s):  
Mathew Orner ◽  
Michael Greminger ◽  
Amit Goyal
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Tumors ◽  
Cutting Tool ◽  
The United States ◽  
Dural Tears ◽  
Burr Holes ◽  
The Brain ◽  
Gain Access

A craniotomy is a procedure where a piece of the skull is removed in order to gain access to the brain. This is commonly done to remove brain tumors, treat epilepsy, and to treat traumatic brain injury. Currently, the craniotomy procedure involves drilling one or more burr holes and then using a craniotome to complete the cut. The craniotome consists of a rotating cutting tool and a dura guard, which is intended to prevent the cutting tool from touching the dura. However, even with the dura guard, dural tears occur in approximately 20–30% of craniotomy procedures [1], [2]. There are approximately 160,000 craniotomies performed per year in the United States [3]. Dural tears add time to the craniotomy procedure due to the increased difficulty in suturing the dura and the potential need to use synthetic dura material in order to reclose the dura. Also, if the dura tears while using the craniotome, the brain is no longer protected as the craniotomy is completed. There is a strong desire among neurosurgeons to have an improved tool for craniotomies that reduces the incidence of dural tears.

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