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Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions
  1. Renee Y Hsia1,2,
  2. Amy J Markowitz3,
  3. Feng Lin4,
  4. Joanna Guo1,
  5. Debbie Y Madhok1,
  6. Geoffrey T Manley5
  1. 1 Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
  2. 2 Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
  3. 3 Brain and Spinal Injury Center (BASIC), University of California, San Francisco, San Francisco, California, USA
  4. 4 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
  5. 5 Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Renee Y Hsia; renee.hsia{at}


Objective To describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs.

Design We performed a retrospective cohort study.

Setting We analysed non-public patient-level data from California’s Office of Statewide Health Planning and Development for years 2005 to 2014.

Participants We identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI.

Primary and secondary outcome measures Our main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge.

Results We found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346–487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission.

Conclusions The large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI.

  • traumatic brain injury
  • emergency department
  • revisits
  • readmissions
  • adult brain injury

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  • Contributors RYH, AJM and GTM contributed to the conception and design of the study. RYH, FL and JG contributed to the analysis and interpretation of the data. RYH acquired the data. GTM acquired the funding. DYM, RYH and JG drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the manuscript.

  • Funding This study was supported in part by NIH 1U01 NS086090-01 (GTM), One Mind (GTM and AJM) and a gift from the Fisher Family.

  • Competing interests GTM discloses grants from the US Department of Defense – TBI Endpoints Development Initiative (Grant #W81XWH-14-2-0176), TRACK-TBI Precision Medicine (Grant #TBD) and TRACK-TBI NETWORK (Grant # W81XWH-15-9-0001); National Institutes of Health - National Institute of Neurological Disorders and Stroke – TRACK-TBI (#U01NS086090); and the National Football League (NFL) Scientific Advisory Board – TRACK-TBI LONGITUDINAL. US Department of Energy supports GTM for a precision medicine collaboration. One Mind has provided funding for TRACK-TBI patients stipends and support to clinical sites. He has received an unrestricted gift from the NFL to the University of California, San Francisco Foundation to support research efforts of the TRACK-TBI NETWORK. GTM has also received funding from NeuroTrauma Sciences LLC to support TRACK-TBI data curation efforts. Additionally, Abbott Laboratories has provided funding for add-in TRACK-TBI clinical studies. AJM receives funding from the Department of Defense TRACK-TBI NETWORK (Grant # W81XWH-15-9-0001) and salary support from the US Department of Energy precision medicine collaboration and One Mind.

  • Patient consent Not required.

  • Ethics approval This study used deidentified, precollected data and was therefore deemed exempt from review by the University of California, San Francisco Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are available through the California Office of Statewide Health Planning and Development.

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