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Flores-Sandoval C, MacKenzie HM, McIntyre A, Sait M, Teasell R, Bateman EA. Mortality and discharge disposition among older adults with moderate to severe traumatic brain injury. Arch Gerontol Geriatr 2024; 125:105488. [PMID: 38776698 DOI: 10.1016/j.archger.2024.105488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE This study examined the research on older adults with a moderate to severe traumatic brain injury (TBI), with a focus on mortality and discharge disposition. METHOD Systematic searches were conducted in MEDLINE, CINAHL, EMBASE and PsycINFO for studies up to April 2022 in accordance with PRISMA guidelines. RESULTS 64 studies, published from 1992 to 2022, met the inclusion criteria. Mortality was higher for older adults ≥60 years old than for their younger counterparts; with a dramatic increase for those ≥80 yr, with rates as high as 93 %. Similar findings were reported regarding mortality in intensive care, surgical mortality, and mortality post-hospital discharge; with an 80 % rate at 1-year post-discharge. Up to 68.4 % of older adults were discharged home; when compared to younger adults, those ≥65 years were less likely to be discharged home (50-51 %), compared to those <64 years (77 %). Older adults were also more likely to be discharged to long-term care (up to 31.6 %), skilled nursing facilities (up to 46.1 %), inpatient rehabilitation (up to 26.9 %), and palliative or hospice care (up to 58 %). CONCLUSION Given their vulnerability, optimizing outcomes for older adults with moderate-severe TBI across the healthcare continuum is critical.
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Affiliation(s)
| | - Heather M MacKenzie
- Parkwood Institute Research, Lawson Research Institute, London, Ontario, Canada; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
| | - Amanda McIntyre
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Muskan Sait
- Parkwood Institute Research, Lawson Research Institute, London, Ontario, Canada; University College Cork, Ireland
| | - Robert Teasell
- Parkwood Institute Research, Lawson Research Institute, London, Ontario, Canada; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada.
| | - Emma A Bateman
- Parkwood Institute Research, Lawson Research Institute, London, Ontario, Canada; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
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Craig HA, Lowe DJ, Khan A, Paton M, Gordon MW. Exploring the impact of traumatic injury on mortality: An analysis of the certified cause of death within one year of serious injury in the Scottish population. Injury 2024; 55:111470. [PMID: 38461710 DOI: 10.1016/j.injury.2024.111470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Few studies effectively quantify the long-term incidence of death following injury. The absence of detailed mortality and underlying cause of death data results in limited understanding and a potential underestimation of the consequences at a population level. This study takes a nationwide approach to identify the one-year mortality following injury in Scotland, evaluating survivorship in relation to pre-existing comorbidities and incidental causes of death. STUDY DESIGN This retrospective cohort study assessed the one-year mortality of adult trauma patients with an Injury Severity Score ≥ 9 during 2020 using the Scottish Trauma Audit Group (STAG) registry linked to inpatient hospital data and death certificate records. Patients were divided into three groups: trauma death, trauma-contributed death, and non-trauma death. Kaplan-Meier curves were used for survival analysis to evaluate mortality, and cox proportional hazards regression analysed risk factors linked to death. RESULTS 4056 patients were analysed with a median age 63 years (58-88) and male predominance (55.2 %). Falls accounted for 73.1 % of injuries followed by motor vehicle accidents (16.3 %) and blunt force (4.9 %). Extremity was the most commonly injured region overall followed by chest and head. However, head injury prevailed in those who died. The registry demonstrated a one-year mortality of 19.3 % with 55 % deaths occurring post-discharge. Of all deaths reported, 35.3 % were trauma deaths, and 47.7 % were trauma-contributed deaths. These groups accounted for over 70 % of mortality within 30 days of hospital admission and continued to represent the majority of deaths up to 6 months post-injury. Patients who died after 6 months were mainly the result of non-traumatic causes, frequently circulatory, neoplastic, and respiratory diseases (37.7 %, 12.3 %, 9.1 %, respectively). Independent risk factors for one-year mortality included a GCS ≤ 8, modified Charlson Comorbidity score >5, Injury Severity Score >25, serious head injury, age and sex. CONCLUSION With a one-year mortality of 19.3 %, and post-discharge deaths higher than previously appreciated, patients can face an extended period of survival uncertainty. As mortality due to index trauma lasted up to 6 months post-admission, short-term outcomes fail to represent trauma burden and so cogent survival predictions should be avoided in clinical and patient settings.
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Affiliation(s)
- Hannah A Craig
- University of Glasgow School of Medicine, G12 8QQ, Glasgow, United Kingdom.
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, United Kingdom; Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, United Kingdom
| | - Angela Khan
- Scottish National Audit Programme, Area 143c, Clinical & Protecting Health Directorate, Public Health Scotland, 1 South Gyle Crescent, Edinburgh EH12 9EB, United Kingdom
| | - Martin Paton
- Scottish National Audit Programme, Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, United Kingdom
| | - Malcolm Wg Gordon
- Department of Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, United Kingdom
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Albrecht JS, Gardner RC, Bahorik AL, Xia F, Yaffe K. Psychiatric Disorders Are Common Among Older US Veterans Prior to Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00159. [PMID: 38833711 DOI: 10.1097/htr.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To estimate the impact of traumatic brain injury (TBI) on prevalence of posttraumatic stress disorder (PTSD), depression, and alcohol and substance use disorders. SETTING A random sample of Veteran's Health Administration data. PARTICIPANTS A total of 14 116 veterans aged ≥55 with incident late-life TBI between October 1, 1999, and September 31, 2021, were matched 1:3 on age and TBI date to 42 678 veterans without TBI. DESIGN Retrospective cohort study. MAIN MEASURES PTSD, depression, and alcohol and substance use disorders were identified using diagnostic codes. Participants were censored after the first diagnosis during the year before and the year after the TBI or matched date. Prevalence rates of PTSD, depression, alcohol, and substance use disorders were compared before and after incident TBI or matched date using Poisson regression. RESULTS Pre-TBI prevalence rates of disorders were higher among those with TBI relative to those without TBI. Pre-TBI PTSD prevalence rates (per 1000 person-years) were 126.3 (95% CI, 120.2-132.4) compared to 21.5 (95% CI, 20.1-22.9) in the non-TBI cohort. In adjusted models, TBI was not associated with an increase in the prevalence of any of the studied disorders. CONCLUSIONS Prevalence rates of depression, PTSD, and alcohol and substance use disorders were 5 to 10 times higher among older veterans before incident TBI. We did not observe an increase in the prevalence of these disorders after incident TBI. Older veterans with these disorders may be at increased risk for TBI.
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Affiliation(s)
- Jennifer S Albrecht
- Author Affiliations: Department of Epidemiology and Public Health (Dr Albrecht), University of Maryland School of Medicine, Baltimore, Maryland; Joseph Sagol Neuroscience Center (Dr Gardner), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; San Francisco Veterans Affairs Medical Center (Ms Xia and Dr Yaffe), San Francisco, California; Department of Psychiatry (Drs Bahorik and Yaffe), Department of Epidemiology & Biostatistics (Dr Yaffe), Department of Neurology (Dr Yaffe) , University of California San Francisco, San Francisco, California; and Northern California Institute for Research and Education (Ms Xia), San Francisco, California
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Coelho LMG, Blacker D, Hsu J, Newhouse JP, Westover MB, Zafar SF, Moura LMVR. Association of Early Seizure Prophylaxis With Posttraumatic Seizures and Mortality: A Meta-analysis With Evidence Quality Assessment. Neurol Clin Pract 2023; 13:e200145. [PMID: 37066107 PMCID: PMC10101717 DOI: 10.1212/cpj.0000000000200145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/11/2023] [Indexed: 04/18/2023]
Abstract
Purpose of the Review To evaluate the quality of evidence about the association of primary seizure prophylaxis with antiseizure medication (ASM) within 7 days postinjury and the 18- or 24-month epilepsy/late seizure risk or all-cause mortality in adults with new-onset traumatic brain injury (TBI), in addition to early seizure risk. Results Twenty-three studies met the inclusion criteria (7 randomized and 16 nonrandomized studies). We analyzed 9,202 patients, including 4,390 in the exposed group and 4,812 in the unexposed group (894 in placebo and 3,918 in no ASM groups). There was a moderate to serious bias risk based on our assessment. Within the limitations of existing studies, our data revealed a lower risk for early seizures in the ASM prophylaxis group compared with placebo or no ASM prophylaxis (risk ratio [RR] 0.43, 95% confidence interval [CI] 0.33-0.57, p < 0.00001, I 2 = 3%). We identified high-quality evidence in favor of acute, short-term primary ASM use to prevent early seizures. Early ASM prophylaxis was not associated with a substantial difference in the 18- or 24-month risk of epilepsy/late seizures (RR 1.01, 95% CI 0.61-1.68, p = 0.96, I 2 = 63%) or mortality (RR 1.16, 95% CI 0.89-1.51, p = 0.26, I 2 = 0%). There was no evidence of strong publication bias for each main outcome. The overall quality of evidence was low and moderate for post-TBI epilepsy risk and all-cause mortality, respectively. Summary Our data suggest that the evidence showing no association between early ASM use and 18- or 24-month epilepsy risk in adults with new-onset TBI was of low quality. The analysis indicated a moderate quality for the evidence showing no effect on all-cause mortality. Therefore, higher-quality evidence is needed as a supplement for stronger recommendations.
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Affiliation(s)
- Lilian Maria Godeiro Coelho
- Department of Neurology (LMGC, MBW, SFZ, LMVRM), Massachusetts General Hospital; Department of Neurology (MBW, SFZ, LMVRM), Harvard Medical School; Department of Epidemiology (DB), Harvard T.H. Chan School of Public Health; Department of Psychiatry (DB), Massachusetts General Hospital; Department of Psychiatry (DB), Harvard Medical School; Department of Health Care Policy (JH, JPN), Harvard Medical School; Mongan Institute (JH), Massachusetts General Hospital; Department of Medicine (JH), Harvard Medical School, Boston; National Bureau of Economic Research (JPN), Cambridge; Department of Health Policy and Management (JPN), Harvard T.H. Chan School of Public Health, Boston; and Harvard Kennedy School (JPN), Cambridge, MA
| | - Deborah Blacker
- Department of Neurology (LMGC, MBW, SFZ, LMVRM), Massachusetts General Hospital; Department of Neurology (MBW, SFZ, LMVRM), Harvard Medical School; Department of Epidemiology (DB), Harvard T.H. Chan School of Public Health; Department of Psychiatry (DB), Massachusetts General Hospital; Department of Psychiatry (DB), Harvard Medical School; Department of Health Care Policy (JH, JPN), Harvard Medical School; Mongan Institute (JH), Massachusetts General Hospital; Department of Medicine (JH), Harvard Medical School, Boston; National Bureau of Economic Research (JPN), Cambridge; Department of Health Policy and Management (JPN), Harvard T.H. Chan School of Public Health, Boston; and Harvard Kennedy School (JPN), Cambridge, MA
| | - John Hsu
- Department of Neurology (LMGC, MBW, SFZ, LMVRM), Massachusetts General Hospital; Department of Neurology (MBW, SFZ, LMVRM), Harvard Medical School; Department of Epidemiology (DB), Harvard T.H. Chan School of Public Health; Department of Psychiatry (DB), Massachusetts General Hospital; Department of Psychiatry (DB), Harvard Medical School; Department of Health Care Policy (JH, JPN), Harvard Medical School; Mongan Institute (JH), Massachusetts General Hospital; Department of Medicine (JH), Harvard Medical School, Boston; National Bureau of Economic Research (JPN), Cambridge; Department of Health Policy and Management (JPN), Harvard T.H. Chan School of Public Health, Boston; and Harvard Kennedy School (JPN), Cambridge, MA
| | - Joseph P Newhouse
- Department of Neurology (LMGC, MBW, SFZ, LMVRM), Massachusetts General Hospital; Department of Neurology (MBW, SFZ, LMVRM), Harvard Medical School; Department of Epidemiology (DB), Harvard T.H. Chan School of Public Health; Department of Psychiatry (DB), Massachusetts General Hospital; Department of Psychiatry (DB), Harvard Medical School; Department of Health Care Policy (JH, JPN), Harvard Medical School; Mongan Institute (JH), Massachusetts General Hospital; Department of Medicine (JH), Harvard Medical School, Boston; National Bureau of Economic Research (JPN), Cambridge; Department of Health Policy and Management (JPN), Harvard T.H. Chan School of Public Health, Boston; and Harvard Kennedy School (JPN), Cambridge, MA
| | - M Brandon Westover
- Department of Neurology (LMGC, MBW, SFZ, LMVRM), Massachusetts General Hospital; Department of Neurology (MBW, SFZ, LMVRM), Harvard Medical School; Department of Epidemiology (DB), Harvard T.H. Chan School of Public Health; Department of Psychiatry (DB), Massachusetts General Hospital; Department of Psychiatry (DB), Harvard Medical School; Department of Health Care Policy (JH, JPN), Harvard Medical School; Mongan Institute (JH), Massachusetts General Hospital; Department of Medicine (JH), Harvard Medical School, Boston; National Bureau of Economic Research (JPN), Cambridge; Department of Health Policy and Management (JPN), Harvard T.H. Chan School of Public Health, Boston; and Harvard Kennedy School (JPN), Cambridge, MA
| | - Sahar F Zafar
- Department of Neurology (LMGC, MBW, SFZ, LMVRM), Massachusetts General Hospital; Department of Neurology (MBW, SFZ, LMVRM), Harvard Medical School; Department of Epidemiology (DB), Harvard T.H. Chan School of Public Health; Department of Psychiatry (DB), Massachusetts General Hospital; Department of Psychiatry (DB), Harvard Medical School; Department of Health Care Policy (JH, JPN), Harvard Medical School; Mongan Institute (JH), Massachusetts General Hospital; Department of Medicine (JH), Harvard Medical School, Boston; National Bureau of Economic Research (JPN), Cambridge; Department of Health Policy and Management (JPN), Harvard T.H. Chan School of Public Health, Boston; and Harvard Kennedy School (JPN), Cambridge, MA
| | - Lidia M V R Moura
- Department of Neurology (LMGC, MBW, SFZ, LMVRM), Massachusetts General Hospital; Department of Neurology (MBW, SFZ, LMVRM), Harvard Medical School; Department of Epidemiology (DB), Harvard T.H. Chan School of Public Health; Department of Psychiatry (DB), Massachusetts General Hospital; Department of Psychiatry (DB), Harvard Medical School; Department of Health Care Policy (JH, JPN), Harvard Medical School; Mongan Institute (JH), Massachusetts General Hospital; Department of Medicine (JH), Harvard Medical School, Boston; National Bureau of Economic Research (JPN), Cambridge; Department of Health Policy and Management (JPN), Harvard T.H. Chan School of Public Health, Boston; and Harvard Kennedy School (JPN), Cambridge, MA
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Pappadis MR, Malagaris I, Kuo YF, Leland N, Freburger J, Goodwin JS. Care patterns and predictors of community residence among older patients after hospital discharge for traumatic brain injury. J Am Geriatr Soc 2023; 71:1806-1818. [PMID: 36840390 PMCID: PMC10330166 DOI: 10.1111/jgs.18308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 02/26/2023]
Abstract
BACKGROUND An increasing number of older adults with traumatic brain injury (TBI) require hospitalization, but it is unknown whether they return to their community following discharge. We examined community residence following acute hospital discharge for TBI in Texas and identified factors associated with 90-day community residence and readmission. METHODS We conducted a retrospective cohort study using 100% Texas Medicare claims data of patients older than 65 years hospitalized for a TBI from January 1, 2014, through December 31, 2017, and followed for 20 weeks after discharge. Discharges to short-term and long-term acute hospital, inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term nursing home (NH), and hospice were identified. The primary outcome was 90-day community residence. Our secondary outcome was 90-day, all-cause readmission. RESULTS In Texas, 26,985 Medicare fee-for-service patients were hospitalized for TBI (Racial and ethnic minorities: 21.1%; Females 57.3%). At 90 days and 20 weeks following discharge, 80% and 84% were living in the community respectively. Female sex (OR = 1.16 [1.08-1.25]), Hispanic ethnicity (OR = 2.01 [1.80-2.25]), "other" race (OR = 2.19 [1.73-2.77]), and prior primary care provider (PCP; OR = 1.51 [1.40-1.62]) were associated with increased likelihood of 90-day community residence. Patients aged 75+, prior NH residence, dual eligibility, prior TBI diagnosis, and moderate-to-severe injury severity were associated with decreased likelihood of 90-day community residence. Being non-Hispanic Black (HR = 1.33 [1.20-1.46]), discharge to SNF (HR = 1.56 [1.48-1.65]) or IRF (HR = 1.49 [1.40-1.59]), having prior PCP (HR = 1.23 [1.17-1.30]), dual eligibility (HR = 1.11 [1.04-1.18]), and prior TBI diagnosis (HR = 1.05 [1.01-1.10]) were associated with increased risk of 90-day readmission. Female sex and "other" race were associated with decreased risk of 90-day readmission. CONCLUSIONS Most older adults with TBI return to the community following hospital discharge. Disparities exist in returning to the community and in risk of 90-day readmission following hospital discharge. Future studies should explore how having a PCP influences post-hospital outcomes in chronic care management of older patients with TBI.
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Affiliation(s)
- Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, TX, USA
- Sealy Center on Aging, UTMB, Galveston, TX, USA
| | - Ioannis Malagaris
- Department of Biostatistics and Data Science, School of Public and Population Health, UTMB, Galveston, TX, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, UTMB, Galveston, TX, USA
- Department of Biostatistics and Data Science, School of Public and Population Health, UTMB, Galveston, TX, USA
| | - Natalie Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Janet Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James S. Goodwin
- Sealy Center on Aging, UTMB, Galveston, TX, USA
- Department of Internal Medicine, Division of Geriatrics, School of Medicine, UTMB, Galveston, TX
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Lercher K, Kumar RG, Hammond FM, Zafonte RD, Hoffman JM, Walker WC, Verduzco-Gutierrez M, Dams-O’Connor K. Distal and Proximal Predictors of Rehospitalization Over 10 Years Among Survivors of TBI: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2023; 38:203-213. [PMID: 36102607 PMCID: PMC9985661 DOI: 10.1097/htr.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the rates and causes of rehospitalization over a 10-year period following a moderate-severe traumatic brain injury (TBI) utilizing the Healthcare Cost and Utilization Project (HCUP) diagnostic coding scheme. SETTING TBI Model Systems centers. PARTICIPANTS Individuals 16 years and older with a primary diagnosis of TBI. DESIGN Prospective cohort study. MAIN MEASURES Rehospitalization (and reason for rehospitalization) as reported by participants or their proxies during follow-up telephone interviews at 1, 2, 5, and 10 years postinjury. RESULTS The greatest number of rehospitalizations occurred in the first year postinjury (23.4% of the sample), and the rates of rehospitalization remained stable (21.1%-20.9%) at 2 and 5 years postinjury and then decreased slightly (18.6%) at 10 years postinjury. Reasons for rehospitalization varied over time, but seizure was the most common reason at 1, 2, and 5 years postinjury. Other common reasons were related to need for procedures (eg, craniotomy or craniectomy) or medical comorbid conditions (eg, diseases of the heart, bacterial infections, or fractures). Multivariable logistic regression models showed that Functional Independence Measure (FIM) Motor score at time of discharge from inpatient rehabilitation was consistently associated with rehospitalization at all time points. Other factors associated with future rehospitalization over time included a history of rehospitalization, presence of seizures, need for craniotomy/craniectomy during acute hospitalization, as well as older age and greater physical and mental health comorbidities. CONCLUSION Using diagnostic codes to characterize reasons for rehospitalization may facilitate identification of baseline (eg, FIM Motor score or craniotomy/craniectomy) and proximal (eg, seizures or prior rehospitalization) factors that are associated with rehospitalization. Information about reasons for rehospitalization can aid healthcare system planning. By identifying those recovering from TBI at a higher risk for rehospitalization, providing closer monitoring may help decrease the healthcare burden by preventing rehospitalization.
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Affiliation(s)
- Kirk Lercher
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai
| | - Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai
| | - Flora M. Hammond
- Department of Physician Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, Indiana
| | - Ross D. Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - William C. Walker
- Dept. of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine at UT Health San Antonio, San Antonio, Texas
| | - Kristen Dams-O’Connor
- Brain Injury Research Center, Professor, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1163, New York
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Bailey MD, Gambert S, Gruber-Baldini A, Guralnik J, Kozar R, Qato DM, Shardell M, Albrecht JS. Traumatic Brain Injury and Risk of Long-Term Nursing Home Entry among Older Adults: An Analysis of Medicare Administrative Claims Data. J Neurotrauma 2023; 40:86-93. [PMID: 35793112 PMCID: PMC10162579 DOI: 10.1089/neu.2022.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of injury-related disability among older adults, and there is increasing interest in post-discharge management as this population grows. We evaluated the association between TBI and long-term nursing home (NH) entry among a nationally representative sample of older adults. We identified 207,355 adults aged ≥65 years who received a diagnosis of either a TBI, non-TBI trauma, or were uninjured between January 2008 and June 2015 from a 5% sample of Medicare beneficiaries. The NH entry was operationalized as the first NH admission that resulted in a stay ≥100 days. Time to NH entry was calculated as the difference between the NH entry date and the index date (the date of TBI, non-TBI trauma, or inpatient/outpatient visit in the uninjured group). We used cause-specific Cox proportional hazards models with stabilized inverse probability of exposure weights to model time to NH entry as a function of injury in the presence of death as a competing risk and generated hazard ratios (HR) and 95% confidence intervals (CI). After excluding beneficiaries living in a NH at index, there were 60,600 TBI, 63,762 non-TBI trauma, and 69,893 uninjured beneficiaries in the sample. In weighted models, beneficiaries with TBI entered NHs at higher rates relative to the non-TBI trauma (HR 1.15; 95% CI 1.10, 1.20) and uninjured (HR 1.67; 95% CI 1.60, 1.74) groups. Future research should focus on interventions to retain older adult TBI survivors within the community.
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Affiliation(s)
- M. Doyinsola Bailey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Steven Gambert
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rosemary Kozar
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Danya M. Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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TBI and risk of death in military veterans over 14 years: Injury severity, timing, and cause of death. J Psychiatr Res 2022; 156:200-205. [PMID: 36257114 DOI: 10.1016/j.jpsychires.2022.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
The objective of this study was to determine the association of traumatic brain injury (TBI) with mortality in military veterans and whether this association differs as a function of TBI severity, timing, and cause of death. This national cohort study used U.S. Department of Veterans Affairs' (VA) data of patients 18 years and older with TBI diagnoses (N = 213,290) and 1:1 propensity-matched comparison random sample of patients without TBI (N = 213,290). The main outcome measure was mortality within 6 months of TBI diagnosis and longer-term (after 6 months). Cox proportional hazards models were used to examine risk of all-cause mortality according to TBI severity and Fine-Gray proportional hazards regression to examine time to cause-specific mortality, accounting for competing risk of other deaths. For patients with moderate-to-severe TBI (compared with no TBI), hazard ratios (HRs) for mortality were highest within first 6 months of injury (fully-adjusted HR: 2.42, 95% CI: 2.32-2.53); for mild TBIs, HRs for mortality were lower and relatively constant over time (fully-adjusted HR within first 6 months: 1.33, 95% CI: 1.26-1.39). Veterans with mild and moderate-to-severe TBI had higher risk of future death over short term for 9 out 10 of the U.S. leading causes of death, with only unintentional injury, stroke, and suicide showing differences by TBI severity. Associations attenuated significantly from within to after 6 months TBI diagnosis. These findings indicate that adults with TBI are at increased risk of majority of leading causes of death, with differential risk by TBI severity and timing of death.
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Sultanoğlu H, Demir MC, Boğan M. Trends in Geriatric Trauma Emergency Department Admissions During COVID-19. J Trauma Nurs 2022; 29:125-130. [PMID: 35536340 DOI: 10.1097/jtn.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of coronavirus disease-2019 (COVID-19) on geriatric trauma presenting to the emergency department is unknown. OBJECTIVE To examine geriatric trauma emergency department admission trends during the COVID-19 pandemic. METHODS This retrospective, observational, comparison study was conducted in an academic emergency department in Turkey. Trauma patients 65 years and older who presented to the emergency department within 1 year of March 12, 2020, were included. Patients admitted in the same date range in the previous year were included as the control group. The characteristics of the patients, injured area, and injury mechanisms were compared. RESULTS Geriatric trauma admissions decreased (relative risk = 0.71, odds ratio [OR] = 0.69 [95% confidence interval, CI: 0.62, 0.77], p < .001). According to the type of injury, there was no significant difference in admissions to the emergency department (p = .318). During the pandemic, there was an increase in falls and a decrease in stab wounds and gunshot wounds (p = .001). Multiple trauma (OR = 5.56 [95% CI: 3.75, 8.23], p < .001), fall (OR = 2.41 [95% CI: 1.6, 3.73], p < .001), and-assault related injuries (OR = 4.43 [95% CI: 2.06, 9.56], p < .001) were determined as factors that increased the admissions to the emergency department compared with the prepandemic. CONCLUSION Although geriatric trauma emergency department admissions decreased during the pandemic, those due to falls and assaults increased. Although curfews and social isolation resulted in a decrease in penetrating injuries, assault-related trauma has increased.
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Affiliation(s)
- Hasan Sultanoğlu
- Department of Emergency Medicine, School of Medicine, Düzce University, Düzce, Turkey
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10
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Yang C, Lang L, He Z, Hui J, Jiang J, Gao GY, Feng JF. Epidemiological Characteristics of Older Patients with Traumatic Brain Injury in China. J Neurotrauma 2022; 39:850-859. [PMID: 35171687 DOI: 10.1089/neu.2021.0275] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Increasing traumatic brain injury (TBI) among older adults constitutes a substantial socioeconomic burden, in step with the growing aging global population. Here, we aimed to investigate the profile of geriatric TBI in the CENTER-TBI China registry, a prospective observational study conducted in 56 centers of 22 provinces across China. Patients admitted to the hospital with a clinical diagnosis of TBI were enrolled in the study. Data on demographic characteristics, injury, clinical features, treatments, and survival at discharge were collected and assessed. The primary endpoint was survival state at discharge. We analyzed a total of 2415 patients aged ≥65 years, accounting for 18.34% of the overall population. The median age was 72 years (interquartile range [IQR]: 68-78), and 1588 (65.76%) were men. Incidental falls (n=1044, 43.23%) were the leading cause of TBI, followed by road traffic injuries (n=1034, 42.82%). Roads and homes were the main sites of injury. The median Glasgow Coma Scale (GCS) score was 13 (IQR: 9-15); 1397 (57.85%) patients had mild TBI (GCS 13-15), while 530 (21.95%) and 488 (20.21%) presented with moderate (GCS 9-12) and severe TBI (sTBI; GCS 3-8), respectively. A total of 546 (22.61%) patients underwent intracranial surgery. The overall in-hospital mortality rate was 8.24% (n=199), and most survivors were transferred home. This study revealed that the demographic patterns and injury mechanisms are changing among elderly patients with TBI in China. More attention should be given to the high incidence of geriatric TBI to improve prevention and management strategies.
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Affiliation(s)
- Chun Yang
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China., Department of Neurosurgery, 160 Pujian Road, Shanghai, Shanghai, China, 200127;
| | - Lijian Lang
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Neurosurgery, Shanghai, Shanghai, China;
| | - Zhenghui He
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Neurosurgery, Shanghai, Shanghai, China;
| | - Jiyuan Hui
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Neurosurgery, Shanghai, Shanghai, China;
| | - Jiyao Jiang
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Department of Neurosurgery, Shanghai, China.,Shanghai Institute of Head Trauma, Shanghai, China;
| | - Guo-Yi Gao
- Shanghai General Hospital, 12482, Department of Neurosurgery, Shanghai, China;
| | - Jun-Feng Feng
- Renji hospital, Shanghai Jiaotong University, Neurosurgery Department, No.1630, Dongfang Road, Shanghai, China, 200127;
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11
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Souesme G, Voyer M, Gagnon É, Terreau P, Fournier-St-Amand G, Lacroix N, Gravel K, Vaillant MC, Gagné MÈ, Ouellet MC. Barriers and facilitators linked to discharge destination following inpatient rehabilitation after traumatic brain injury in older adults: a qualitative study. Disabil Rehabil 2021; 44:4738-4749. [PMID: 34126821 DOI: 10.1080/09638288.2021.1919212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify facilitators and barriers associated with returning home for older adults having received inpatient rehabilitation after traumatic brain injury (TBI). METHODS A qualitative design was used. Five older patients with TBI and four family caregivers were interviewed and six healthcare professionals participated in a focus group. RESULTS Main facilitators to returning home highlighted by all participants were: (1) Patient's adequate health condition and functional status, (2) Access to health and other services at home, (3) Availability of help from a family caregiver. Conversely, if one of these factors was not met, it represented a barrier. Other facilitators identified were (4) Attachment to one's home, (5) Feeling of commitment toward a loved one, (6) Having the possibility of going through a transitional phase, (7) United front between the patient and the family caregiver towards a return home. Additional barriers to returning home included: (8) Incongruent perspectives, and (9) Unclear knowledge about available health and other services at home. CONCLUSION The results of this study could be translated into a practical tool to guide patients, families and professionals in the decision about returning home or exploring an alternative option after inpatient rehabilitation for TBI in older adults.IMPLICATIONS FOR REHABILITATIONWhen orienting an older patient home or to an alternative living environment after a traumatic brain injury (TBI), the perspective of rehabilitation professionals can differ from that of patients and caregivers.Professionals tend to emphasize security, whereas patients and caregivers' focus on the well-being associated with home and on the importance of being with their loved one.Integrating the views, values and wishes of older patients with TBI and their caregivers will support a shared decision-making approach for orientation after rehabilitation.
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Affiliation(s)
- Guillaume Souesme
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Manon Voyer
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Éric Gagnon
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada.,Sociology Department, Laval University, Québec, Canada
| | - Paule Terreau
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Geneviève Fournier-St-Amand
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Nadine Lacroix
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Kristina Gravel
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Claude Vaillant
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Ève Gagné
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Christine Ouellet
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
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12
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Hung KKC, Rainer TH, Yeung JHH, Cheung C, Leung Y, Leung LY, Chong M, Ho HF, Tsui KL, Cheung NK, Graham C. Seven-year excess mortality, functional outcome and health status after trauma in Hong Kong. Eur J Trauma Emerg Surg 2021; 48:1417-1426. [PMID: 34086062 DOI: 10.1007/s00068-021-01714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose was to investigate long-term health impacts of trauma and the aim was to describe the functional outcome and health status up to 7 years after trauma. METHODS We conducted a prospective, multi-centre cohort study of adult trauma patients admitted to three regional trauma centres with moderate or major trauma (ISS ≥ 9) in Hong Kong (HK). Patients were followed up at regular time points (1, 6 months and 1, 2, 3, 4, 5, 6, and 7 years) by telephone using extended Glasgow Outcome Scale (GOSE) and the Short-Form 36 (SF36). Observed annual mortality rate was compared with the expected mortality rate estimated using the HK population cohort. Linear mixed model (LMM) analyses examined the changes in SF36 with subgroups of age ≥ 65 years, ISS > 15, and GOSE ≥ 5 over time. RESULTS At 7 years, 115 patients had died and 48% (138/285) of the survivors responded. The annual mortality rate (AMR) of the trauma cohort was consistently higher than the expected mortality rate from the general population. Forty-one percent of respondents had upper good recovery (GOSE = 8) at 7 years. Seven-year mean PCS and MCS were 45.06 and 52.06, respectively. LMM showed PCS improved over time in patients aged < 65 years and with baseline GOSE ≥ 5, and the MCS improved over time with baseline GOSE ≥ 5. Higher mortality rate, limited functional recovery and worse physical health status persisted up to 7 years post-injury. CONCLUSION Long-term mortality and morbidity should be monitored for Asian trauma centre patients to understand the impact of trauma beyond hospital discharge.
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Affiliation(s)
- Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Timothy H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Emergency Medicine Unit, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Janice Hiu Hung Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Catherine Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yuki Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Marc Chong
- School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hiu Fai Ho
- Accident and Emergency Department, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Kwok Leung Tsui
- Trauma Committee, New Territory West Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Nai Kwong Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Colin Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. .,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong.
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