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Department of Epidemiology and Public Health (Drs Albrecht, Hirshon, and Smith), Department of Emergency Medicine (Dr Hirshon), and Department of Anesthesiology, Divisions of Trauma Anesthesiology and Surgical Critical Care, R. Adams Cowley Shock Trauma Center (Dr McCunn), University of Maryland School of Medicine, Baltimore; Departments of Physical Medicine and Rehabilitation (Dr Bechtold) and Psychiatry & Behavioral Sciences (Dr Rao), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (Dr Simoni-Wastila); and Shock, Trauma and Anesthesiology Research (STAR)-Organized Research Center, National Study Center for Trauma and Emergency Medical Services, University of Maryland, Baltimore (Drs Hirshon and Smith).
Published: March 2018
AI Article Synopsis
Article Abstract
Objective: To 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 in 2009-2010 captured by the National Hospital Ambulatory Medical Care Survey.
Participants: Aged 65 years and older.
Measurements: Mild TBI defined by International Classification of Diseases, Ninth Revision, Clinical Modification, 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 of 14 or more 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 a diagnosis of mild TBI.
Results: Rates of ED visits for mild TBI were 386 per 100 000 among those aged 65 to 74 years, 777 per 100 000 among those aged 75 to 84 years, and 1205 per 100 000 among those older than 84 years. Rates for women (706/100 000) were higher than for men (516/100 000). Compared with a possible mild TBI, a diagnosis of mild TBI was more likely in the West (odds ratio = 2.31; 95% confidence interval, 1.02-5.24) and less likely in the South/Midwest (odds ratio = 0.52; 95% confidence interval, 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.
