Examination of multiple injuries and comorbidities in persons hospitalized with traumatic brain injury using national-level data — United States, 2006–2010

Background: In persons with traumatic brain injury (TBI), the presence of either non-TBI co-occurring injuries or comorbidities may increase hospitalization lengths of stay or complicate recovery. Co-occurring injuries and comorbidities among persons hospitalized with TBI have not been described at a national level in the US. Methods: Data from the 2006–2010 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample were analyzed for hospitalizations with TBI listed as the principal or secondary diagnosis. Both co-occurring injuries and comorbidities were identified. Co-occurring injuries were categorized using the Barell Injury Diagnosis Matrix. Comorbidities were classified using Elixhauser categories. Data are presented as averages over the study period. Results: Co-occurring injuries were present in 65.2% of 315,619 TBI hospitalizations. The most common co-occurring injuries were open wounds of the head and neck (N=75,757), extremity fractures (N=55,257), head and neck contusions and superficial injuries (N=44,809), and non-TBI head and neck fractures (N=43,343). Depending on their age group, between 75%–90% of persons with transportation-related TBIs had co-occurring injuries. Comorbidities were diagnosed in 68.7% of TBI hospitalizations. The most common comorbid diseases included hypertension (33.7%), fluid and electrolyte disorders (17.2%), alcohol abuse (15.2%), uncomplicated diabetes (10.8%), and chronic pulmonary disease (9.5%). Other comorbid diseases also included other neurologic disorders (5.2%) and drug abuse (5.1%). Conclusions: Additional injuries and non-injury comorbid diseases were frequently found among persons hospitalized and diagnosed with TBI. Medical and public health professionals should understand how these conditions may affect outcomes in persons with TBI.