Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions

Abstract

ObjectiveTo describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs.DesignWe performed a retrospective cohort study.SettingWe analysed non-public patient-level data from California’s Office of Statewide Health Planning and Development for years 2005 to 2014.ParticipantsWe identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI.Primary and secondary outcome measuresOur main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge.ResultsWe found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346–487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission.ConclusionsThe large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI.

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

“…4 The TBI incidence rate has been increasing. 3,[5][6][7] Falls are the most common cause, especially in young children and older adults. 8 The vast majority of TBIs (up to 90%) 9 are classified as "mild" (mTBI), meaning that they involve no or only a brief (<30min) loss of consciousness and period of posttraumatic amnesia (<24h).…”

Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

“…Additionally, the upward trend in TBI-related ED visits during both ICD-CM eras could be attributed to many factors: willingness to seek medical care and visit an ED, increased health insurance coverage, older adults with a higher incidence of TBI among an aging population, and/or increased incidence of TBI (Hsia et al 2018 ; Nikpay et al 2017 ). Reporting bias due to shifting care from EDs to urgent care or outpatient settings during the ICD-10-CM period seems an unlikely alternative explanation of the study findings, unless such shifting occurred differently for patients treated and released from EDs with TBI diagnoses than for patients diagnosed with unspecified head injury.…”

“…Studies assessed the positive predictive values (PPV) of the ICD-10-CM codes for TBI and unspecified head injury treated in the EDs or the PPV of TBI codes among hospitalizations but did not assess the impact of the proposed change in the surveillance definition on the magnitude and trend in TBI rates (Gabella et al 2021 ; Peterson et al 2021 ; Warwick et al 2020 ). Studies have assessed changes in TBI ED rates during the ICD-9-CM era, but have not assessed trends for a period covering the transition to ICD-10-CM as well (Hsia et al 2018 ; Taylor et al 2017 ). One study of the transition to ICD-10-CM using interrupted time series focused on TBI-related hospitalizations among a subpopulation of adults aged 19–44 years in 2011–2017 where the primary reason (principal diagnosis) for the hospitalization was any traumatic injury (Sebastião et al 2021 ).…”

The Impact of a Care Transitions Intervention on People With Brain Injuries and Their Caregivers

“…Functional ability is associated with depression (Ottenbacher et al, 2001). Care Transitions may have the opportunity to close gaps in disparities experienced among Latina/o/Hispanic brain injury survivors and their caregivers (Hsia et al, 2018). Since family and personal relationships are so important to Latina/o populations, the Care Transitions' intervention embraces these characteristics by supporting the whole family and conducting face-to-face home visits to develop personal relationships with the family members over time.…”

“…In addition to the challenges brain injury patients and families encounter posthospitalization, there is evidence of health disparities among certain ethnic groups. Between 2005 and 2014, Latinx (Latinas and Latinos from Latin America living in the U.S.) brain-injury survivors' emergency room visit rates increased by 60.2% compared to 42.7% among white non-Latina/o patients (Hsia et al, 2018). Thirty-day hospital readmissions, defined as any unplanned hospital admission since discharge, among brain injury survivors ranged from 17-18% for Latinx and 10-14% for non-Latinx survivors (Gardener et al, 2018;Ottenbacher et al, 2001).…”