Brain Injury Newsroom

This Evident Shift Away From Inpatient Care Underscores The Need For Surveillance Of TBI Patients Treated In Emergency Departments And Other Outpatient Setting

The consistency of findings in these seven States, located in different regions of the United States, suggests that these data may be broadly representative of the Nation as a whole. The epidemiologic patterns of TBI described in this report also resemble those from an analysis of 1994 National Hospital Discharge Survey (NHDS) data, which obtained hospital discharge data from a sample of 478 participating hospitals located across the United States. The crude TBI-related hospitalization rate estimated in the NHDS was 94 per 100,000 population.2 The combined TBI-related hospitalization rate obtained from Arizona, Colorado, Minnesota, Missouri, New York State, Oklahoma, and South Carolina is approximately 20 percent lower than the corresponding rate estimated from the NHDS. Different sampling and other methods that may explain this rate difference have not yet been elucidated.

The rates in this report are substantially lower than rates previously reported in studies conducted from 1974 to 1986 (approximately 200 cases per 100,000 population annually).7-16 In comparison, from 1979 to 1992, the TBI-associated death rate declined 22 percent, largely because of a decrease in TBI-related deaths associated with motor-vehicle crashes.3 The findings in this report and those from the NHDS suggest a decline of approximately 50 percent in combined morbidity and death during a corresponding interval, indicating a disproportionately large reduction in rates of nonfatal TBI resulting in hospitalization. This decrease may reflect successes in injury prevention efforts but may also be the result of recent changes in hospital admission policies that encourage outpatient care for less severe injuries.

This evident shift away from inpatient care underscores the need for surveillance of TBI patients treated in emergency departments and other outpatient settings. The National Center for Health Statistics National Health Interview Survey (NHIS) has provided some information on the incidence of TBI treated on an outpatient basis.1 In 1991, an estimated 1.54 million non-institutionalized U.S. civilians sustained a brain injury that resulted in loss of consciousness but was not severe enough to cause death or long-term institutionalization, according to self-reported NHIS data collected with the 1991 Injury Supplement. Of these 1.54 million persons, 25 percent received no medical care for their TBI, 49 percent received care in an emergency department or other outpatient site, 9 percent received overnight hospital care, and 16 percent were admitted to a hospital for two or more days.