Significant mortality and morbidity were evident at 5 years postinjury. The deterioration in global outcomes observed regardless of age suggests that multiple influences contribute to poorer outcomes. Public health interventions intended to reduce post-acute inpatient rehabilitation mortality and morbidity rates will need to be multifaceted and age-specific.

Objective To determine whether the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) is representative of individuals aged 16 years and older admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI). Design Secondary analysis of existing datasets. Setting Acute inpatient rehabilitation facilities. Participants Patients 16 years of age and older with a primary rehabilitation diagnosis of TBI. Interventions None. Main Outcome Measure demographic characteristics, functional status and hospital length of stay. Results From October 2001 through December 2007 patients included in the TBIMS-NDB were largely representative of all individuals 16 years and older admitted for rehabilitation in the U.S. with a primary diagnosis of TBI. The major difference in distribution was age—the TBIMS-NDB cohort did not include as many patients over age 65 as were admitted for rehabilitation with a primary diagnosis of TBI in the United States. Distributional differences for age-related characteristics were observed; however, groups of patients partitioned at age 65 differed minimally, especially the under 65 subset. Regardless of age, the proportion of patients with a rehabilitation stay of 1-9 days was larger nationwide. Nationwide admissions showed an age distribution similar to patients discharged alive from acute care with moderate, severe or penetrating TBI. The proportion of patients age 70 and older admitted for TBI rehabilitation in the United States increased every year, a trend that was not evident in the general population, TBIMS-NDB or among TBI patients in acute care. Conclusions These results provide substantial empirical evidence that the TBIMS-NDB is representative of patients receiving inpatient rehabilitation for TBI in the U.S. Researchers utilizing the TBIMS-NDB may want to adjust statistically for the lower percentage of patients over age 65 or those with stays less than 10 days.

No abstract

Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The factors predicting these outcomes remain poorly understood, and age-specific care guidelines for TBI do not exist. This study provides an overview of TBI in older adults using data from the National Trauma Data Bank (NTDB) gathered between 2007 and 2010, evaluates age group-specific trends in rates of TBI over time using U.S. Census data, and examines whether routinely collected information is able to predict hospital discharge status among older adults with TBI in the NTDB. Results showed a 20-25% increase in trauma center admissions for TBI among the oldest age groups (those > = 75 years), relative to the general population, between 2007 and 2010. Older adults ( > = 65 years) with TBI tended to be white females who have incurred an injury from a fall resulting in a ''severe'' Abbreviated Injury Scale (AIS) score of the head. Older adults had more in-hospital procedures, such as neuroimaging and neurosurgery, tended to experience longer hospital stays, and were more likely to require continued medical care than younger adults. Older age, injury severity, and hypotension increased the odds of in-hospital death. The public health burden of TBI among older adults will likely increase as the Baby Boom generation ages. Improved primary and secondary prevention of TBI in this cohort is needed.

No abstract