Epidemiology of traumatic brain injuries at a rural-serving Level II trauma center, 2004 - 2016

ABSTRACT

Objective

To describe the epidemiology of traumatic brain injury (TBI) and quantify rural and urban differences.

Methods

Patient characteristics, injury characteristics, imaging, and outcomes were extracted from the trauma registry of the level II trauma center at Essentia Health-St. Mary’s Medical Center, Duluth, MN, for patients admitted for a TBI from January 1, 2004, through December 31, 2016. Estimated relative risk (RR) per year, Wald 95% confidence intervals, and p-values were calculated.

Results

Of the 5,079 TBI admissions during the study period, just under half (2,510, 49.4%) resided in rural areas at the time of admission. Overall, there was a 3.8% unadjusted annual increase in TBI risk rom 2004–2016, with 2.9% and 4.7% annual increases among rural and urban U.S. residents, respectively. Rural residents had significant annual increases in risk of TBI admission resulting in 30-day post-discharge emergency department readmission and 30-day post-discharge combined inpatient/emergency department readmission of 35.2% and 22.4%, respectively.

Conclusions

We found that risk of rural resident TBI admission due to MVC was significantly greater than that for urban residents. Public health and medical interventions to decrease the rural/urban disparity are warranted, including public health campaigns to increase seat belt use, and supportive care post-discharge into rural communities.

KEYWORDS:

• Traumatic brain injury
• hospital admissions
• epidemiology
• urban
• rural

Acknowledgments

The authors acknowledge the trauma registry registrars for their assistance with data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

The project was reviewed and approved by the Institutional Review Board at Essentia Health.

Authors’ contributions

CAM acquired funding, participated in the design of the study and drafted the manuscript. CMR conducted the statistical analyses and assisted in drafting the manuscript. PGC assisted in the design of the study and interpretation of results. LEV assisted in the conception of the study and oversaw data acquisition. VUO assisted in the conception of the study and data interpretation. SDE assisted in funding acquisition, study conception and data interpretation. TAW assisted with drafting the manuscript. All authors read and approved the final manuscript.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

Grant support from Essentia Health Duluth Clinic Foundation. The funding agency had no role in the study other than provision of funding.