Increased Rates of Mild Traumatic Brain Injury Among Older Adults in US Emergency Departments, 2009-2010

Abstract

Objective Estimate rates of emergency department (ED) visits for mild traumatic brain injury (TBI) among older adults. We defined possible mild TBI cases to assess underdiagnoses. Design Cross-sectional Setting National sample of ED visits 2009-2010 captured by The National Hospital Ambulatory Medical Care Survey. Participants Aged 65 and older Measurements Mild TBI defined by ICD-9-CM codes (800.0x-801.9x, 803.xx, 804.xx, 850.xx-854.1x, 950.1x-950.3x, 959.01) and a Glasgow Coma Scale score ≥14 or missing, excluding those admitted to the hospital. Possible mild TBI was defined similarly among those without mild TBI and with a fall or motor vehicle collision as cause of injury. We calculated rates of mild TBI and examined factors associated with diagnosis of mild TBI. Results Rates of ED visits for mild TBI were 386/100,000 among those 65-74; 777/100,000 among those 75-84; and 1,205/100,000 among those >84. Rates for women (706/100,000) were higher than for men (516/100,000). Compared to possible mTBI, diagnosis of mild TBI was more likely in the West (OR 2.31; 95%CI 1.02, 5.24) and less likely in the South/Midwest (OR 0.52; 95%CI 0.29, 0.96) than in the Northeast. Conclusions This study highlights an upward trend in rates of ED visits for mild TBI among older adults.

Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury

“…1 Further, rates of TBI among older adults are increasing. 1,2 Older adults have the highest rates of hospitalization and mortality following TBI and are more likely to experience poor cognitive and functional outcomes, nursing home placement, and mortality compared to younger adults with similar injury severity. 1,3-6 …”

Combination therapies for neurobehavioral and cognitive recovery after experimental traumatic brain injury: Is more better?

“…With an estimated incidence of two million cases in the United States each year (Faul et al, 2010; Albrecht et al, 2015), and several million more worldwide (Hyder et al, 2007), traumatic brain injury (TBI) is a significant health care issue (Max et al, 1991; Thurman and Guerrero, 1999; Hyder et al, 2007; Summers et al, 2009; Coronado et al, 2011). Motor vehicle accidents and falls resulting in a blow to the head are the typical causes of TBI in the general population, whereas blasts and shrapnel from improvised explosive devices are the leading causes for military personnel in active war zones (Ling et al, 2009; Cernak and Noble-Haeusslein, 2010; Young et al, 2015).…”

Risk of Mortality in Individuals with Hip Fracture and Traumatic Brain Injury

“…Given the same mechanism of injury (falls) as hip fracture and known barriers to diagnosis in older adults, the low prevalence of TBI in this study suggests that it is underdiagnosed in individuals with hip fracture. 11,14,15 Although there are no existing data on the true prevalence of TBI in individuals with hip fracture, it is important to undertake studies to ascertain this. Even with this conservative estimate of TBI prevalence, it significantly increased risk of mortality and may be associated with other poor outcomes.…”

“…More than 70% of TBIs are mild and can even occur without direct head impact, being caused by the rapid acceleration and deceleration that occur during a fall . Older adults may be less likely to receive treatment for TBI and to receive an accurate diagnosis . This is particularly important in older adults with hip fracture, in whom the acute pain from the fracture may mask symptoms of TBI.…”

“…11 Older adults may be less likely to receive treatment for TBI and to receive an accurate diagnosis. [14][15][16] This is particularly important in older adults with hip fracture, in whom the acute pain from the fracture may mask symptoms of TBI. Thus, TBI sustained during the fall that resulted in hip fracture could contribute to poorer outcomes, including cognitive impairment and mortality.…”