Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

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Abstract

Objective

Comorbid disorders influence the course and outcomes of rehabilitation following traumatic brain injury (TBI), yet sex- and age-related disparities in the frequency distribution of these disorders remain poorly understood. We aimed to describe comorbid disorders by the International Classification of Diseases in patients with TBI undergoing inpatient rehabilitation in Ontario, Canada over a 3-year period, by sex and age, and discuss their potential impact on rehabilitation outcomes.

Results

The percentage of TBI patients with one or more comorbid disorder is higher among older (≥65 years) men and women than among those who are younger or middle-aged (<65 years). Among younger and middle-aged patients, multiple injuries and trauma, mental health conditions, and nervous system disorders were the most prevalent comorbidities. In older patients, circulatory, endocrine, nutritional, metabolic, and immune disorders were the most prevalent comorbidities. Our results suggest that a multisystem view of rehabilitation of men and women with TBI across age categories is needed to reflect the complex clinical profile of TBI patients undergoing rehabilitation.

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The online version of this article (doi:10.1186/s13104-017-2682-x) contains supplementary material, which is available to authorized users.

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Most cited references 29

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Population based study on patients with traumatic brain injury suggests increased risk of dementia.

Chao-Yuan Huang, KANG LU, Liang Wang … (2012)

The relationship between traumatic brain injury (TBI) and the risk of dementia remains controversial. This population based study was designed to estimate and compare the risk of dementia in TBI and non-TBI individuals during the 5 year period after TBI. This study was a retrospective cohort study. Data were obtained from the Longitudinal Health Insurance Database 2000. We included 44,925 patients receiving ambulatory or hospital care and 224,625 non-TBI patients; patients were matched for sex, age and year of index use of healthcare. Patients <15 years of age and those admitted to the intensive care unit were excluded. Each individual was studied for 5 years to identify the subsequent development of dementia. Data were analysed by Cox proportional hazard regression. During the 5 year follow-up period, 1196 TBI (2.66%) and 224,625 non-TBI patients (1.53%) patients developed dementia. During the 5 year follow-up period, TBI was independently associated with a 1.68 (range 1.57-1.80) times greater risk of dementia after adjusting for sociodemographic characteristics and selected comorbidities. The findings of this study suggest an increased risk of dementia among individuals with TBI. We suggest the need for more intensive medical monitoring and health education in individuals with TBI.

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Patients with traumatic brain injury: population-based study suggests increased risk of stroke.

Jiunn-Horng Kang, Ching-Po Lin, Shun-Hua Chen (2011)

Previous studies have identified an array of morbidities following traumatic brain injury (TBI), including certain neurological disorders. However, no direct evidence has been reported on the link between TBI and stroke. This population-based study was designed to estimate the risk of stroke during a period of 5 years following a TBI, compared with individuals who did not suffer TBI during the same period. Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID 2000). A total of 23 199 patients receiving ambulatory or hospitalization care with a diagnosis of TBI were included, together with 69 597 non-TBI patients as our comparison group, matched by sex, age, and year of index use of health care. Each individual was followed for 5 years to identify subsequent occurrence of stroke. Cox proportional hazard regressions were performed for analysis. During the 3-month follow-up period, 675 strokes (2.91%) occurred in TBI patients and in 207 patients (0.30%) in the non-TBI comparison cohort. A diagnosis of TBI was independently associated with a 10.21 (95% CI, 8.71-11.96), 4.61 (95% CI, 4.16-5.11), and 2.32 (95% CI, 2.17-2.47) times greater risk of stroke during 3-month, 1-year, and 5-year follow-up, respectively, after adjusting for sociodemographic characteristics and selected comorbidities. The risk of intracerebral hemorrhage was more noticeable among patients with TBI compared with those without a TBI. This is the first report showing an increased risk of stroke among individuals who have sustained a TBI. We suggest a need for more intensive medical monitoring and health education following TBI, especially during the first few months and years.

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Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution

Mickaël Cardinale, Henry Boret, Erwan D'Aranda … (2017)

OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI. METHODS The authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation. RESULTS In total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9-34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7-80.9), cervical spine injury (OR 13.5, 95% CI 3.1-59.4), thoracic trauma (OR 7.3, 95% CI 1.1-51.2), and hepatic lesion (OR 13.3, 95% CI 2.1-84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication. CONCLUSIONS Blunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.

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Author and article information

Contributors

Vincy Chan: 416-597-3422 , vincy.chan@uhn.ca

Tatyana Mollayeva: 416-597-3422 , tatyana.mollayeva@utoronto.ca

Kenneth J. Ottenbacher: 409-747-1637 , kottenba@utmb.edu

Angela Colantonio: 416-978-1098 , angela.colantonio@utoronto.ca

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central (London )

ISSN (Electronic): 1756-0500

Publication date (Electronic): 8 August 2017

Publication date PMC-release: 8 August 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 371

Affiliations

[1 ]ISNI 0000 0001 0692 494X, GRID grid.415526.1, , Toronto Rehabilitation Institute-University Health Network, ; Toronto, Ontario Canada

[2 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Rehabilitation Sciences Institute, Faculty of Medicine, , University of Toronto, ; Toronto, Ontario Canada

[3 ]ISNI 0000 0001 1547 9964, GRID grid.176731.5, Division of Rehabilitation Science, Center for Recovery, Physical Activity and Nutrition, School of Health Professions, , University of Texas Medical Branch, ; Galveston, Texas USA

Article

Publisher ID: 2682

DOI: 10.1186/s13104-017-2682-x

PMC ID: 5549298

PubMed ID: 28789695

SO-VID: 099d8d7b-ac68-43de-8196-7e8c5ab073a8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 17 April 2017

Date accepted : 22 July 2017

Funding

Funded by: Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (NIH)

Award ID: R24HD065702

Award Recipient : Kenneth J. Ottenbacher

Funded by: NIH Research Award

Award ID: 1R21 HD08106-01

Award Recipient : Angela Colantonio

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ScienceOpen disciplines: Medicine

Keywords: traumatic brain injury,inpatient rehabilitation,sex,age,index disease,comorbidity,multimorbidity,prevalence

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ScienceOpen disciplines: Medicine

Keywords: traumatic brain injury, inpatient rehabilitation, sex, age, index disease, comorbidity, multimorbidity, prevalence

Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 29

Population based study on patients with traumatic brain injury suggests increased risk of dementia.

Patients with traumatic brain injury: population-based study suggests increased risk of stroke.

Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution

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