Population-based estimates of outcomes after hospitalization for traumatic brain injury in Colorado

doi:10.1016/j.apmr.2003.08.107

Archives of Physical Medicine and Rehabilitation

Volume 85, Supplement 2, April 2004, Pages 73-81

https://doi.org/10.1016/j.apmr.2003.08.107 Get rights and content

Abstract

Whiteneck G, Brooks CA, Mellick D, Harrison-Felix C, Terrill MS, Noble K. Population-based estimates of outcomes after hospitalized for traumatic brain injury in Colorado. Arch Phys Med Rehabil 2004;85(4 Suppl 2):S73–81.

Objective

To determine statewide, population-based outcomes of persons hospitalized with traumatic brain injury (TBI) at 1 year postinjury.

Design

Follow-up survey of a representative cohort.

Setting

A statewide, population-based registry and follow-up system for persons hospitalized with TBI.

Participants

A total of 1591 adult Coloradoans with moderate and severe injury oversampled, but weighted to be representative of persons hospitalized with TBI (1996–1999) who survived their injuries and completed follow-up telephone interviews at 1 year postinjury.

Interventions

Not applicable.

Main outcome measures

Checklists of symptoms and service utilization, the FIM instrument™, the Craig Handicap Assessment and Reporting Technique Short Form, a single-item quality of life (QOL) measure, and a needs assessment checklist.

Results

Problematic outcomes occurring at 1 year postinjury included one third or more being bothered by fatigue, feeling irritable or grouchy, having headaches, and experiencing trouble sleeping more frequently than preinjury; 37% reported needing the assistance of another person in physical and/or cognitive activities of daily living; substantial participation restrictions were noted in areas of occupation (30%) and social integration (22%); and 29% responded that their QOL was only fair or poor. Negative outcomes were reported more frequently among individuals who were more severely injured, older, or female.

Conclusions

Substantial percentages of people hospitalized with TBI in a population-based sample reported a variety of problematic outcomes at 1 year postinjury.

Section snippets

Participants

Colorado residents, who were hospitalized for the first time with, or died from TBI in Colorado each year, were identified using the Colorado Hospital Association’s Discharge Data Set as well as the Colorado Division of Health Statistics and Vital Records death certificates.12 Subjects with diagnostic codes 800.0 to 801.9, 803.0 to 804.9, and 850.0 to 854.1 from the International Classification of Diseases, Ninth Revision, Clinical Modification,13 as per CDC guidelines,14 were included. From

Results

Table 1 provides demographic information about the study population. The average age was 41 years (range, 16–96y). Sixty-eight percent were men and 80% had mild injuries based on a GCS score of 13 to 15. Table 2 presents the crosstabulation of cases by injury severity, age, and gender. It indicates that severe injuries occurred more frequently among younger people and men.

Discussion

The CTBIRFS provides the first statewide, population-based estimates of outcomes after hospitalization for TBI. Follow-up data from CTBIRFS are more likely to be representative of all individuals hospitalized with TBI than previous investigations that followed on people treated in rehabilitation facilities where a disproportionately large percentage of more severely injured individuals would be treated. Although the Traumatic Brain Injury Model Systems studies (funded by the National Institute

Conclusions

Promising future research is suggested by this investigation. Considerable secondary analysis of the CTBIRFS data set is warranted to address additional research questions. Furthermore, the specific limitations of this investigation suggest the need for further research, including investigation of TBI outcomes in children and an investigation of TBI outcomes among individuals who have not been hospitalized. Advancing the study of TBI outcomes in mild, not hospitalized, cases is well justified

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^☆: Supported by a cooperative agreement between the US Centers for Disease Control and Prevention (CDC), the Colorado Department of Public Health and Environment (CDPHE), and Craig Hospital (grant no. U17/CCU812447). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or CDPHE.

¹: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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ArticlePopulation-based estimates of outcomes after hospitalization for traumatic brain injury in Colorado1☆,

Abstract

Objective

Design

Setting

Participants

Interventions

Main outcome measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Clin Epidemiol

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Am J Emerg Med

Federal Interagency Head Injury Task Force report

Traumatic brain injury in the United Statesa report to Congress

Incidence of mild and moderate brain injury in the United States, 1991

Brain Inj

Injury in Colorado

Epidemiology of disability from traumatic brain injury

Descriptive findings from the traumatic brain injury model systems national database

J Head Trauma Rehabil

The Traumatic Brain Injury Model Systems of Care

The National Institute on Disability and Rehabilitation Research TBI Model Systems Program

Mild head injuryfacts and artifacts

J Clin Exp Neuropsychol

Neurobehavioral outcome following minor head injurya three center study

J Neurosurg

International classification of disease 9th revision, clinical modification

Guidelines for surveillance of central nervous system injury

The Injury Severity Scorean update

J Trauma

Article
Population-based estimates of outcomes after hospitalization for traumatic brain injury in Colorado¹☆,