We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Specialized care and recurrent traumatic brain injury: a retrospective cohort study.
- Authors
Lasry, O.; Marcoux, J.; Buckeridge, D.
- Abstract
Introduction: Many traumatic brain injury (TBI) patients suffer a recurrent TBI (rTBI). These patients are at a higher risk of poor cognitive and functional outcomes compared to patients with a single injury. However, interventions that may mitigate the risk of rTBI are currently unknown. Objective: This study aimed to determine whether the care provided for an index mild TBI (mTBI) in neurotrauma centre emergency departments (specialized care) is associated with a lower risk of rTBI at one-year follow-up when compared to the care provided in non-neurotrauma centre emergency departments (non-specialized care). Methods: A retrospective cohort study of all patients incurring mTBI and being treated in an emergency department from 1998 to 2014 was completed. Each patient had a follow-up period of up to one year. Administrative data for a 25% random sample of the Greater Montréal area were used to ascertain cases, outcomes and covariates. A time-to-event analysis was conducted using a Cox proportional hazards model, taking into account the time-dependent effects of the type of care received. Important confounders were included in the model to adjust for confounding. A sensitivity analysis using an instrumental variable (differential distance between a patient's closest neurotrauma and non-neurotrauma centre) was used to assess for residual confounding. Results: During the study period there were 24 292 (19 516 non-specialized care and 4776 specialized care) mTBI patients that presented to an emergency department. A total of 1384 rTBI (5.7%) cases occurred during a one-year follow-up of each patient. After adjusting for confounders and the time-dependent effect of the type of care received, patients treated in neurotrauma centre emergency departments had a 36% reduction in the hazard of rTBI with a hazard ratio (HR) of 0.64 (95% CI: 0.51-0.80) in the first week after the index injury compared to patients treated in non-specialized emergency departments. This protective effect persisted for the first six weeks after the index injury. Over the one-year follow-up period, the overall reduction in the hazard of rTBI was 21% (HR = 0.79, 95% CI: 0.68-0.91) for patients treated in the specialized care setting. The instrumental variable sensitivity analysis supported these findings. Conclusion: The treatment of mTBI patients in the emergency department of neurotrauma centres is associated with an important decrease in the occurrence of rTBI. Further research that identifies the mediators of this association is warranted so that specific interventions that lower the risk of rTBI can be implemented.
- Subjects
BRAIN injuries; NERVOUS system injuries; SENSITIVITY analysis; ANALYSIS of covariance; PROPORTIONAL hazards models
- Publication
Health Promotion & Chronic Disease Prevention in Canada, 2016, Vol 36, Issue 11, p268
- ISSN
2368-738X
- Publication type
Article