Trends in Head Injury Incidence in New Zealand: A Hospital-Based Study from 1997/1998 to 2003/2004

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Abstract

Traumatic brain injury (TBI) is a leading cause of disability and death in young adults. Globally, the incidence of TBI hospitalizations is estimated at 200–300 people per 100,000 annually. Using a national health database, we examined the incidence of TBI-related hospital discharges (including 1-day stays) to New Zealand Hospitals from 1997/1998 to 2003/2004. Crude annual hospital-based incidence rates for the total population ranged from 226.9 per 100,000 in 1998/1999 to a high rate of 349.2 in 2002/2003. There was a noticeable increase in rates with the change from ICD-9 to ICD-10 diagnostic codes and there was also disparity in incidence rates according to ethnicity, age and gender. Crude annual hospital-based incidence rates for males and females in Maori (689/100,000 and 302.8/100,000 person-years) and Pacific Island populations (582.6/100,000 and 217.6/100,000 person-years) were much higher than those for the remaining population (435.4/100,000 and 200.9/100,000 person-years), particularly for males. The overall age-standardized hospital- based incidence rate for 2003/2004 was 342 per 100,000 per year (95% CI = 337–349/100,000), and 458 per 100,000 per year for Maori (95% CI = 438–479/100,000) with Maori males experiencing a peak in incidence between 30 and 34 years of age that was not evidenced for the wider population. Standardized hospital-based incidence rates for the total population and for Maori by age, gender and ICD-10 diagnostic codes are also examined.

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Most cited references 13

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Traumatic brain injury in the United States: A public health perspective.

D Thurman, C M ALVERSON, K. Dunn … (1999)

Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 people die, 230,000 people are hospitalized and survive, and an estimated 80,000-90,000 people experience the onset of long-term disability. Rates of TBI-related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and also to changes in hospital admission practices that shift the care of persons with less severe TBI from inpatient to outpatient settings. The magnitude of TBI in the United States requires public health measures to prevent these injuries and to improve their consequences. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in TBI incidence, enable the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs. State follow-up registries, built on surveillance systems, can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities to design, implement, and evaluate cost-effective programs for people living with TBI and for their families, addressing acute care, rehabilitation, and vocational, school, and community support.

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Family stressors in traumatic brain injury: a two-year follow-up.

Karyl M. Hall, Peter Karzmark, Marie Stevens … (1994)

A review of the literature suggests that psychosocial disability in traumatic brain-injured (TBI) individuals and distress in families continues long after the initial injury. In this study the relationship of family stress to a number of factors was studied longitudinally. Caregivers of 51 TBI inpatients were interviewed at rehabilitation admission and by phone at 6, 12, and 24 months postinjury. Caregivers' most common complaints about their relatives were a lack of involvement in leisure activities, fatigue, slowness, and forgetfulness. Increasingly severe temper outbursts, anxiety, and self-centeredness were reported over time. Aggressiveness was reported by caregivers as moderate or severe in 31% of cases by 2 years postinjury. Of all complaints, only reports of inappropriate social behavior decreased over time. Despite caregivers' increasing complaints about their relatives, there were no trends toward greater self-reported stress over time. At the 2-year assessment, stress was significantly higher for caregivers of those with an at risk psychosocial history, and for those without sufficient funds for services. Caregivers reporting financial strain increased 22% from rehabilitation admission. Forty-seven percent of caregivers had altered or given up their jobs at 1 year postinjury, and 33% at 2 years postinjury. Although self-perceived measurements of stress did not increase over time, caregivers reported notable increases in medication use and substance use, and decreases in employment and financial status over the 2-year time period. When spouse and parent caregiver responses were compared, spouses reported a consistently greater number of behavioral problems, which increased in severity over time. Those behaviors associated with mood disturbances predominated.(ABSTRACT TRUNCATED AT 250 WORDS)

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Recovery at one year following isolated traumatic brain injury: a Western Trauma Association prospective multicenter trial.

Avery Nathens, Gregory Jurkovich, Margaret Knudson … (2005)

Age has been shown to be a primary determinant of survival following isolated traumatic brain injury (TBI). We have previously reported that patients > or =65 years who survived mild TBI have decreased functional outcome at 6 months compared with younger patients. The purpose of this study was to further investigate the effect of age on outcome at 1 year in all patients surviving isolated TBI. The Western Trauma Association multicenter prospective study included all patients sustaining isolated TBI defined as Abbreviated Injury Scale score for Head > or = 3 with an Abbreviated Injury Scale score in any other body area or =60 years (n = 65). More severe TBIs, as measured by admitting Glasgow Coma Scale (GCS), were observed in the youngest group compared with all others but there were no differences in mean GCS between the remaining three groups. There were no differences in neurosurgical intervention between the groups. Age was a major determinant in the outcome at discharge and last follow-up. Patients over 60 years discharged with a GOS < or =4 were less likely to improve at 1 year than all other groups (37% versus 63 to 85%; p < or = 0.05). Patients between 18 and 29 years of age had the lowest mean Glasgow Outcome Scale and discharge FIM scores, which correlated with the low admission GCS. Despite the increased severity of TBI, this group had the best FIM score at 1 year. In contrast, patients older than 60 years had the least improvement and had a significantly lower final FIM score at 1 year compared with all other groups. Older patients following isolated TBI have poorer functional status at discharge and make less improvement at 1 year compared with all other patients. These worse outcomes occur despite what appears to be less severe TBI as measured by a higher GCS upon admission. Differences in outcome begin to appear even in patients between 45 and 59 years. Further investigations with more detailed outcome instruments are required to better understand the qualitative limitations of a patient's recovery and to devise strategies to maximize functional improvement following TBI. Age is an exceedingly important parameter affecting recovery from isolated TBI.

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Journal

Journal ID (publisher-id): NED

Journal ID (nlm-ta): Neuroepidemiology

Journal ID (doi): 10.1159/issn.0251-5350

Title: Neuroepidemiology

Publisher: S. Karger AG

ISSN (Print): 0251-5350

ISSN (Electronic): 1423-0208

Publication date Subscription-year: 2009

Publication date (Print): December 2008

Publication date (Electronic): 08 November 2008

Volume: 32

Issue: 1

Pages: 32-39

Affiliations

^aDepartment of Psychology Clinical Training Programme, University of Auckland, and ^bNational Research Centre for Stroke, Applied Neurosciences and Neurorehabilitation, School of Public Health and Psychology, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand

Article

Publisher ID: 170090 Other ID: Neuroepidemiology 2009;32:32–39

DOI: 10.1159/000170090

PubMed ID: 18997476

SO-VID: 9dbcd010-c1aa-4031-84a5-a0a6b6fb7cf8

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 16 July 2008

Date accepted : 19 August 2008

Page count

Figures: 4, References: 32, Pages: 8

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Trends in Head Injury Incidence in New Zealand: A Hospital-Based Study from 1997/1998 to 2003/2004

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Karger: Neurology and Neuroscience

Most cited references 13

Traumatic brain injury in the United States: A public health perspective.

Family stressors in traumatic brain injury: a two-year follow-up.

Recovery at one year following isolated traumatic brain injury: a Western Trauma Association prospective multicenter trial.

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