Comorbidity in traumatic brain injury and risk of all-cause mortality, functional and financial burden: a decade-long population based cohort study

资助机会：对创伤性脑损伤现有数据库进行二次分析，以探索 与医疗康复相关的结局（R21）; RFA-HD-16-001 PI：COLANTONIO A 项目总结：合并症在创伤性脑损伤（TBI）后和跨 损伤严重程度的范围。它可以在受伤时出现，在受伤后早期出现，或者 住院或住院康复期间。长期随访研究的个人， 已经忍受了TBI报告，患者有许多共存的疾病。然而，我们的 理解何时（即，损伤前或损伤后表现），如何（即，条件如何 影响受伤者及其随后对保健服务的需求）， (i.e.,共病条件造成的负担最大），关于过度使用 资源、功能结果和全因死亡率仍然没有答案。更多的人口- 有必要进行基础研究，以弥补这些研究空白。拟定的回顾性队列 研究将利用所有TBI诊断代码患者的相关数据，这些数据来自急诊室。 部门（国家门诊护理报告系统），急性护理（出院摘要 数据库）、住院康复（国家康复系统）、社区服务和 长期护理（家庭护理数据库），持续护理（持续护理报告系统），以及 处方数据（安大略健康保险计划索赔数据库）超过10年。在 纵向分析的基础是10年期间至少35，000例急性护理病例。 这些数据经过了临床研究所的质量评估和链接， 评估科学，一个非营利的独立组织，进行研究，以提高 加拿大安大略省卫生保健服务的有效性。我们假设， 变量（即，年龄、颅内损伤、损伤机制、损伤严重程度、住院时间）- 目前，在TBI和科摩罗的大多数研究工作的重点， 足以准确预测资源消耗、全因死亡率和功能 TBI患者的结局，按年龄和性别分层。我们进一步假设， 包括患者人口统计学，某些临床（即， 共病）疾病和社会指数，将提供更高的准确性，预测资源 消费，全因死亡率和TBI的功能结果，这些集群将是 随时间而改变。这项关于TBI患者合并症的研究可能会导致 揭示具有挑战性的多方面问题（即，虚弱和患者复杂性）， 目前还没有很好的定义，但一般认为与存在密切相关， 多种共病 十月2015

FUNDING OPPORTUNITY: Secondary analysis of existing databases in traumatic brain injury to explore outcomes relevant to medical rehabilitation (R21); RFA-HD-16-001 PI: COLANTONIO A PROJECT SUMMARY: Comorbidity is prevalent after traumatic brain injury (TBI) and across the spectrum of injury severity. It can be present at the time of injury, arise early after injury, or during hospitalization or inpatient rehabilitation. Long-term follow-up studies of individuals who had endured a TBI report that patients have numerous co-existing disorders. Nevertheless, our comprehension of the when (i.e., pre- or post-injury presentation), how (i.e., how the conditions affect the injured individual and their subsequent demand for health care services) and which (i.e., which comorbid conditions cause the greatest burden), with respect to excessive use of resources, functional outcomes, and all-cause mortality, remain unanswered. Larger population- based studies are necessary to address these research gaps. The proposed retrospective cohort study will utilize linked data of all patients with TBI diagnostic codes, derived from emergency departments (National Ambulatory Care Reporting System), acute care (Discharge Abstract Database), inpatient rehabilitation (National Rehabilitation System), community services and long-term care (Home Care Database), continuing care (Continuing Care Reporting System), and prescription data (Ontario Health Insurance Plan Claims Database) over a 10 year period. At least 35,000 acute care cases over a 10 year period form the basis of the longitudinal analysis. These data have undergone quality assessments and linkage by the Institute for Clinical Evaluation Sciences, a non-profit independent organization that carries out research to improve the effectiveness of health care services in Ontario, Canada. We hypothesize that acutely derived variables (i.e., age, intracranial injury, injury mechanism, injury severity, length of stay) – currently the focus of most research efforts in TBI and comorbidity – are not by themselves sufficient to accurately predict resource consumption, all-cause mortality, and functional outcomes in individuals with TBI, stratified by age and sex. We further hypothesize that an expanded set of factors and factor clusters including patient demographic, certain clinical (i.e., comorbid) disorders and social indices, will provide greater accuracy in predicting resource consumption, all-cause mortality and functional outcomes of TBI, and these clusters will be subject to change over time. This study of comorbidity in patients with TBI may lead to uncovering challenging multifaceted problems (i.e., frailty and patient complexity) that are currently not well defined but generally considered to be closely related to the presence of multiple comorbid disorders. October 2015