Health & Economic Burden of Traumatic Brain Injury in the Emergency Department

Abstract

Objective: To evaluate epidemiological patterns and lifetime costs of traumatic brain injury (TBI) identified in the emergency department (ED) within a publicly insured population in Ontario, Canada, in 2009. Methods: A nationally representative, population-based database was used to identify TBI cases presenting to Ontario EDs between April 2009 and March 2010. We calculated unit costs for medical treatment and productivity loss, and multiplied these by corresponding incidence estimates to determine the lifetime costs of identified TBI cases across age group, sex, and mechanism of injury. Results: In 2009, there were more than 133,000 ED visits for TBI in Ontario, resulting in a conservative estimate of $945 million in lifetime costs. Lifetime cost estimates ranged from $279 million to $1.22 billion depending on the diagnostic criteria used to define TBI. Peak rates of TBI occurred among young children (ages 0-4 year) and the elderly (ages 85+ years). Males experienced a 53% greater rate of TBI and incurred two-fold higher costs compared with females. Falls, sports/bicyclist-related injuries, and motor vehicle crashes represented 47%, 12%, and 10% of TBI presenting to ED, respectively, and accounted for a significant proportion of costs. Conclusions: This study revealed an enormous health and economic burden associated with TBI identified in the ED setting. Our findings underscore the importance of ongoing surveillance and prevention efforts targeted to vulnerable populations. More research is needed to fully appreciate the burden of TBI across a variety of health care settings. Keywords: Concussion, cost of illness, epidemiology, prevention, traumatic brain injury doi:10.1017/cjn.2015.320 Can J Neurol Sci. 2016 43: 238-247 Traumatic brain injury (TBI) is the leading cause of death and disability globally, and it is involved in nearly one-half of all trauma deaths. 1 An estimated 1.7 million TBIs occur in the United States annually, resulting in 1.3 million emergency department (ED) visits and 52,000 deaths. 2 Lifetime costs of medical treatment for severe TBI range from $600,000 to $1.8 million per case, with the value of lost productivity ten-fold higher. 3,4 Additionally, survivors of TBI face long-term neuropsychiatric sequelae and their treatment requires significant health care expenditures. 3,[5][6][7][8][9][10] Efforts to determine the health and economic burden are important for informing public health policy, guiding appropriate allocation of resources, and targeting and evaluating prevention measures.Examining the epidemiology of TBI treated in EDs is of particular importance, as 80% to 92% of TBIs present to the ED, 11,12 and recent studies show a surge in these visits. 2,13,14 Yet, there are few studies examining the health care burden of TBI treated in the ED setting, and none that has calculated the costs

Pathological correlations between traumatic brain injury and chronic neurodegenerative diseases

“…In most cases, TBI results from a physical blow to the head during traumatic events such as falls [22], motor vehicle collisions [23], or sports related injuries [24], although these injuries can also be inflicted by exposure to explosive blasts [25]. TBI is currently classified as mild, moderate, or severe based on clinical observations and history such as duration of loss of consciousness and post traumatic amnesia [26, 27].…”

Pilot single-centre cross-sectional study to determine emergency physicians’ knowledge and management of sports concussion: an experience from Singapore

“…In particular, pathways emanating from the emergency departments (EDs) must be assessed, especially as concussion is a common presentation. (14,15) This is even more important when a patient presents to the ED after sustaining a head injury at a sporting event, where there were no medical professionals trained in immediate care and concussion management available on Page 3 of 17 site. Therefore, the emergency physician (EP) represents the first line of clinical management for concussions.…”

Salsalate treatment following traumatic brain injury reduces inflammation and promotes a neuroprotective and neurogenic transcriptional response with concomitant functional recovery

“…TBI is a major cause of morbidity and mortality throughout the world, with resultant healthcare costs representing a huge economic burden for developed countries (Fu et al, 2016). However, despite decades of basic research and clinical studies, there is not yet an accepted therapy for TBI, and treatment remains limited to supportive care.…”