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Falls Among Elderly Lead to Significantly More TBI Cases at EDs

ATLANTA – Emergency departments treated significantly more traumatic brain injuries (TBI) in 2013 than five years before, with who and why undergoing some important changes.

An article in the national Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report notes that the age-adjusted rate of ED visits was higher in 2013 – 787.1 of 100,000 population vs. 534.4 in 2007.

CDC researchers point out that fall-related TBIs among patients 75 and older made up 17.9% of the increase, adding that the rate of TBI-related hospitalizations also increased among that cohort, from 356.9 in 2007 to 454.4 in 2013, mainly because of falls.

About 2.8 million TBI-related ED visits, hospitalizations, and deaths occurred in the United States in 2013, according to the report. Included were 2.5 million TBI-related ED visits, approximately 282,000 TBI-related hospitalizations, and approximately 56,000 TBI-related deaths.

In fact, study authors add, TBIs were diagnosed in nearly 2.8 million (1.9%) of the approximately 149 million total injury- and noninjury-related EDHDs that occurred in the United States during 2013.

CDC researchers used state-based administrative healthcare data to calculate estimates of TBI-related ED visits and hospitalizations by principal mechanism of injury, age group, sex, and injury intent.

Age was a significant factor in TBI-related EDHDs, they found, with the highest rates, 2,232.2 per 100,000 population, observed among patients 75 and older. The next highest was 1,591.5 for birth to 4 years old and 1,080.7 for 15 to 24 years old. Males had higher age-adjusted rates of TBI-related EDHDs, at 959.0, compared with females at 810.8.

Falls were the most common principal mechanisms of injury for all age groups, accounting for 413.2 per 100,000 injuries. Other significant causes were being struck by or against an object, accounting for 142.1, and motor-vehicle crashes, accounting for 121.7.

Interestingly, according to study authors, motor-vehicle crashes were the leading cause of TBI-related deaths in 2007 in both number and rate, but by 2013, intentional self-harm had replaced them as the leading cause by both measures.

In general, the study suggests that emergency clinicians are doing a good job: The overall age-adjusted rate of TBI-related deaths decreased from 17.9 per 100,000 in 2007 to 17.0 in 2013. Age-adjusted TBI-related death rates caused by falls increased from 3.8 in 2007 to 4.5 in 2013, however, primarily among older adults.

Although the age-adjusted rate of TBI-related deaths attributable to motor-vehicle crashes decreased from 5.0 in 2007 to 3.4 in 2013, the age-adjusted rate of TBI-related ED visits attributable to motor-vehicle crashes increased from 83.8 in 2007 to 99.5 in 2013. At the same time, the age-adjusted rate of TBI-related hospitalizations attributable to motor-vehicle crashes decreased from 23.5 in 2007 to 18.8 in 2013.

More success in preventing motor-vehicle crashes has led to a decrease in the number of TBI-related hospitalizations and deaths from 2007 to 2013, study authors note. During the same period, the rate of fall-related TBIs in older adults has increased markedly.

The researchers called for enhanced fall-prevention efforts in the elderly population.