Epidemiology of Adults Receiving Acute Inpatient Rehabilitation for a Primary Diagnosis of Traumatic Brain Injury in the United States
Epidemiology of Adults Receiving Acute Inpatient Rehabilitation for a Primary Diagnosis of Traumatic Brain Injury in the United States
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DOI：
10.1097/htr.0000000000000012
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发表时间：
2015-03-01
影响因子：
2.4
通讯作者：
Whiteneck, Gale G.
中科院分区：
文献类型：
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作者：
Cuthbert, Jeffrey P.;Harrison-Felix, Cynthia;Whiteneck, Gale G.
目的：估计2001年至2010年间美国因创伤性脑损伤（TBI）初步诊断而接受住院康复治疗的所有青少年和成年人入院和出院时的总体特征和按年龄组划分的特征。设计：次要数据分析。设置：急性住院康复设施。参与者：2001年至2010年期间因初步诊断为TBI而接受住院康复治疗的16岁及以上患者。主要观察指标：功能独立性、残疾程度和生活状况。结果如下：按年龄组分列的创伤性脑损伤发病率发现，80岁及以上的病例比例最大，30岁年龄组的发病率逐渐下降，30岁年龄组的发病率略有上升。受伤主要是由福尔斯（49.8%）和机动车碰撞（40.8%）造成的;然而，最年轻的人受伤主要是由机动车碰撞造成的，随着年龄的增加，受伤率逐渐下降，而福尔斯受伤随着年龄的增加而增加，最老的年龄组最有可能发生TBI。受伤前酒精滥用和物质使用分别发生在总人口的22.9%和12.2%;然而，年龄分布表明，年龄小于50岁的个体中的受伤前使用率较高（例如，20岁和29岁的个体分别为46.4%和30.6%），随着年龄的增加，滥用率降低。在总人口中，49.2%退休，31.1%就业，14.1%不工作，5.6%学生。按年龄划分的趋势显示，较年轻的人更有可能是学生或就业者（例如，20岁和29岁的人分别为14.5%和62.0%），就业状况在30至39岁的人中达到顶峰，最老年龄组（80岁及以上）下降至3.2%。在冲突前后，16至19岁的人独居的趋势变化最小，随着年龄的增长，变化稳步增加。在难民潮前后的居住地变化中也出现了类似的趋势，最年轻的人最有可能回到私人住宅生活，随着年龄的增长，回到私人住宅生活的人逐渐减少。运动和认知子量表评分表明，年轻个体在康复入院时的评分较低，而在康复出院时的评分较高。结论：这项研究提供了2001年至2010年期间美国所有16岁及以上因TBI初步诊断接受住院康复治疗的患者的人口估计数。最近的趋势显示住院TBI康复人群的老龄化。许多对康复结果很重要的特征受年龄的影响，老年人倾向于女性，TBI不太严重，由于福尔斯而引起TBI，但在康复期间表现出较少的改善，更大的残疾，以及他们的生活状况在康复后的更多变化。这些调查结果特别令人感兴趣，因为在这些分析中考虑的最老年龄组不包括婴儿潮人口。
Objective: To estimate the overall and by age-group characteristics at admission and discharge from rehabilitation between 2001 and 2010 of all late-teens and adults undergoing inpatient rehabilitation for a primary diagnosis of traumatic brain injury (TBI) in the United States. Design: Secondary data analysis. Setting: Acute inpatient rehabilitation facilities. Participants: Patients aged 16 years and older receiving inpatient rehabilitation for a primary diagnosis of TBI between 2001 and 2010. Main Outcome Measures: Functional independence, level of disability, and living situation. Results: The incidence of TBI by age group found the largest proportion of cases to be aged 80 years and older, with a gradual decline in incidence in the age group of 30 years, at which point there was a slight increase. Injuries resulted predominantly from falls (49.8%) and motor vehicle crashes (40.8%); however, injuries to the youngest individuals were largely from motor vehicle crashes with decreasing rates as age increased, while injuries due to falls rose as age increased, with the oldest age groups most likely to incur a TBI. Preinjury alcohol misuse and substance use were found to occur in 22.9% and 12.2% of the total population, respectively; however, age distributions demonstrated high preinjury use among individuals younger than 50 years (eg, 46.4% and 30.6% for those aged 20 and 29 years, respectively) with decreasing misuse as age increased. Of the total population, 49.2% were retired, 31.1% employed, 14.1% not working, and 5.6% students. Trends by age showed that younger individuals were more likely to be students or employed (eg, 14.5% and 62.0% for those aged 20 and 29 years, respectively), with employment status peaking for those aged 30 to 39 years, and declining to 3.2% for the oldest age group (80 years and older). The trend of person(s) living alone between pre- and postrehabilitation showed the least amount of change for those aged 16 to 19 years with steadily increasing changes as age increased. Similar trends were seen for residence changes pre- and postrehabilitation, with the youngest most likely to return to living at a private residence, and a gradual decrease in return to living at a private residence as age increased. FIM instrument ("FIM") Motor and Cognitive subscale scores demonstrated that younger individuals had lower scores at admission to rehabilitation and higher scores at rehabilitation discharge. Conclusion: This study provides population estimates for all patients 16 years of age and older receiving inpatient rehabilitation for a primary diagnosis of TBI in the United States between 2001 and 2010. A recent trend shows the aging of the inpatient TBI rehabilitation population. Many characteristics important to rehabilitation outcomes are influenced by age, with older individuals trending toward being female, having less severe TBIs, incurring TBIs as a result of falls, but showing less improvement during rehabilitation, greater resulting disability, and more changes in their living situation postrehabilitation. These findings are of particular interest, as the oldest age groups considered in these analyses did not include the baby boom population.