Disability rates after non-hospitalized traumatic brain injury: A population-based study

The Center for Disease Control and Prevention (CDC) estimates 5.3 million Americans are living with disability after traumatic brain injury based primarily on statewide follow-up surveillance of people hospitalized with TBI, but acknowledges that this estimate probably excludes the outcomes of many people experiencing TBI who are not hospitalized. To examine the rates of non-hospitalized TBI and the rates of disability after non-hospitalized TBI, a statewide, population-based, random-digit-dialed survey was completed by 2,701 adults. The lifetime history of TBI was collected using methodology based on the Ohio State University TBI Identification Method. Long term test-retest reliability was excellent for the assessment of the overall category of maximum TBI severity (ICC=0.77). Information about the place of treatment was requested for the most severe TBI identified (hospitalized, emergency department and released, physician's office or clinic, or no treatment sought). Measures of disability were also administered. Among those reporting TBI with loss of consciousness, 30.5% were treated in the hospital, 36.7% in the emergency department, 8.2% in physicians' offices or clinics, and 24.6% did not seek medical care. For those reporting TBI without loss of consciousness, the percentages were 14.9%, 43.2%, 17.5%, and 24.4% respectively. The rates of disability were significantly related to the severity of the injury, but not the place of treatment. This suggests that the number of individuals living in the United States with disability after TBI may be more than double the CDC estimate.