Prevalence of traumatic brain injury in an ED population

doi:10.1053/ajem.2002.32641

The American Journal of Emergency Medicine

Volume 20, Issue 3, May 2002, Pages 177-180

https://doi.org/10.1053/ajem.2002.32641 Get rights and content

Abstract

The objective of this study was to determine prevalence of traumatic brain injury (TBI) in an emergency department (ED) population. Questionnaires were administered to patients in an urban, university, trauma center ED. All respondents provided demographics; patients reporting TBI were asked age at injury, if they experienced loss of consciousness (LOC), mechanism, or if medical attention was sought. Five hundred one patients completed the survey. Forty-one percent reported TBI; 23% had TBI with LOC. Mean age at injury was 21.5 years. Mechanism was evenly distributed among sports, assaults, falls, and motor vehicle crashes (MVC). Medical attention was sought for 61% of injuries. Men were more likely to report TBI (P < .001). Medical attention was more likely if MVC or LOC and less likely in sports-injured patients (all P < .01). Twenty-five percent of patients with TBI sustained repeat injury by the same mechanism. Prevalence of TBI in this population is high. Many occur by mechanisms that potentially are preventable. (Am J Emerg Med 2002;20:177-180. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Section snippets

Study population

The study was conducted at an urban, university, level 1 trauma center. The ED evaluates 65,000 patients annually, with a pediatric census of 15,000 visits. A single, trained research assistant administered questionnaires to patients presenting to our ED between May 15, 1999 and June 15, 1999. Consecutive patients were enrolled during the hours the research assistant was on duty. Subjects were enrolled during day and evening hours only. All patients were considered eligible. Patients were

Results

Six hundred one patients presented to the ED during the study period when the research assistant was on duty. Seventy patients were too ill to interview or had impaired mental status, 6 did not understand English, 11 had been enrolled previously, and 13 patients refused. Questionnaires were completed with the remaining 501 patients. Summary demographics are shown in Table 1.

. Demographic Characteristics of All Participants in TBI Survey (n = 501)

Total	501
Age at study entry, median (SD)	36.5 (21.3)

Discussion

The overall significance of TBI is undisputed. Patients who sustain moderate or severe injuries require hospitalization, rehabilitation, and long-term care at great personal, financial, and societal cost. The significance of minor head injury is less clear. Several studies indicate short-term alterations in cognitive function after seemingly minor TBI as well as persistent abnormalities associated with repeated minor TBI.23, 24, 25, 26, 27, 28 The societal impact of these findings depends in

Acknowledgements

The authors thank Samantha White for her assistance in manuscript preparation.

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Citation Excerpt :
Similar findings have also been reported in empirical research studies (e.g., Boswell, McErlean, & Verdile, 2002; Setnik & Bazarian, 2007). Boswell et al. (2002), for instance, found that among adults who presented to the ED, 39% self-reported that they had not sought medical treatment for a previous mTBI/concussion, with 36% of this group reporting that their previous injury involved loss of consciousness (LOC). Additional research has reported that some mTBIs/concussions presenting to hospitals are not recorded (Moss & Wade, 1996), particularly if these injuries were considered minor or occurred concurrently with other more serious injuries.
Aggression is widespread and a significant community burden, with violence-related injury deaths representing a significant public health problem. We explore aggression relative to a possible associated factor, traumatic brain injury (TBI). Our focus is on a less well studied population, those recruited through the community who may not have had hospital care or contact with the criminal justice system (e.g. were recruited in schools). This study provides a critical review of the potential relationship between aggression and traumatic brain injury. We undertook a systematic search of published literature of studies recruited through the community and found seven studies examining aggression and TBI. All studies identified a relationship between reports of TBI and aggression, however only two studies were longitudinal in design. The study focuses on the limitations of the current body of research, including in definitions of constructs, the need to understand mediating and moderating factors, and improvements needed in the overall research design of studies.
Neuroepidemiology of traumatic brain injury
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Citation Excerpt :
As such, and in addition to the fact that most cases of mTBI are nonfatal, and individuals may not present to the ED, and also may not have been hospitalized if they did present, historically prevalence rates have not been well documented and estimates are often based on existing disabilities. This is clearly highlighted by the estimated rates of undiagnosed TBIs of 11% (Kraus et al., 1987), 61% (Boswell et al., 2002), and 75% (Kay et al., 1993), and the reported figure of 89 000 undiagnosed TBIs annually (Schootman and Fuortes, 2000). TBI is a significant public-health concern.
Traumatic brain injury (TBI) is a significant public-health concern. TBI is defined as an acute brain injury resulting from mechanical energy to the head from external physical forces. Some of the leading causes of TBI include falls, assaults, motor vehicle or traffic accidents, and sport-related concussion. Two of the most common identified risk factors are sex (males are nearly three times more likely to suffer a TBI than females); and a bimodal age pattern (persons 65 years and older, and children under 14 years old).
It is estimated that approximately 1.5–2 million Americans suffer from TBI annually. TBIs account for around 1.4 million emergency room visits, 275 000 hospital admissions, and 52 000 deaths in the USA each year. TBI contributes to approximately 30% of all deaths in the USA annually. In Australia, it is estimated that approximately 338 700 individuals (1.9% of the population) suffer from a disability related to TBI. Of these, 160 200 were severely or profoundly affected by acquired brain injury, requiring daily support. In the UK, TBI accounted for 3.4% of all emergency department attendances annually. An overall rate of 453 per 100 000 was found for all TBI severities, of which 40 per 100 000 (10.9%) were moderate to severe. TBI often results in residual symptoms that affect an individual's cognition, movement, sensation, and/or emotional functioning. Recovery and rehabilitation from TBI may require considerable resources and may take years. Some individuals never fully recover, and some require lifetime ongoing care and support. TBI has an enormous social and financial cost, with estimates of the annual financial burden associated with TBI ranging between 9 and 10 billion US dollars.
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Citation Excerpt :
Not captured in the TBI ED visits are the TBIs that are seen in outpatient clinics and the TBIs that are undiagnosed, which have been reported to be as high as 89 000 per year (Schootman and Fuortes, 2000). It is estimated that 11% (Fife, 1987), 61% (Boswell et al., 2002), and 75% (Kay et al., 1993) of TBIs are undiagnosed, suggesting that people may not have access to healthcare or that the public may be unclear of when to seek medical attention for a mild TBI. In the US, emergency department visits for TBI have steadily increased over time.
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^☆: Address reprint requests to Mara McErlean, MD, Albany Medical College, Department of Emergency Medicine MC-139, 47 New Scotland Avenue, Albany, NY 12208. E-mail: [email protected].

^☆☆: 0735-6757/02/2003-0008$35.00/0

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Original ContributionsPrevalence of traumatic brain injury in an ED population☆,☆☆

Abstract

Section snippets

Study population

Results

Discussion

Acknowledgements

Community Health Stud

Ann Epidemiol

Neurol Clin

Cortex

Injury

Clin Sports Med

Epidemiology

Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure

JAMA

Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury