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INTRODUCTION TO TBI DATABASE RESEARCH. Juan Carlos Arango, Ph.D Virginia Commonwealth University Medical Center. The Traumatic Brain Injury Model Systems of Care. A project funded by the US Department of Education National Institute on Disability and Rehabilitation Research. Project Design.

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introduction to tbi database research

INTRODUCTION TO TBI DATABASE RESEARCH

Juan Carlos Arango, Ph.D

Virginia Commonwealth University Medical Center

the traumatic brain injury model systems of care

The Traumatic Brain Injury Model Systems of Care

A project funded by the US Department of Education

National Institute on Disability and Rehabilitation Research

project design
Project Design
  • First prospective, longitudinal multi-center study ever conducted which examines the course of recovery and outcomes following the delivery of a coordinated system of acute neurotrauma and inpatient rehabilitation.
  • Includes large scale follow-up to 15 years post-injury.
nidrr funding span 2007 2012 tbims program priorities
NIDRR Funding Span 2007-2012TBIMS Program Priorities

Conduct research that contributes to evidence-based rehabilitation interventions which improve the lives of individuals with TBI.

tbi model system locations
TBI Model System Locations

Currently Funded

Follow-up Center

Previously Funded

definition of tbi
Definition of TBI

Damage to brain tissue caused by an external mechanical force as evidenced by medically documented loss of consciousness or post traumatic amnesia (PTA) due to brain trauma or by objective neurological findings that can be reasonably attributed to TBI on physical examination or mental status examination.

database inclusion criteria
Database Inclusion Criteria
  • Moderate to severe TBI (PTA>24 hrs or LOC>30 minutes or GCS in ED<13 or intracranial neuroimaging abnormalities).
  • Admitted to system’s hospital emergency department within 72 hours of injury.
  • 16 years of age or older at the time of injury.
  • Receives acute care and comprehensive inpatient rehabilitation within the model system hospitals.
  • Informed consent is signed by patient, family or guardian.
database objectives
Database Objectives
  • Study the clinical course of individuals with TBI from time of injury through discharge from acute care and rehabilitation care.
  • Evaluate the recovery and long-term outcome of individuals with TBI.
  • Establish a basis for comparison with other data sources.
tbims national database sample size and attrition rates
TBIMS National DatabaseSample Size and Attrition Rates*

Form I – 8,077 cases

Form II – 24,011 follow-ups

  • Year 1 – 7,339 – 17% attrition
  • Year 2 – 6,208 – 20% attrition
  • Year 5 – 3,776 – 23% attrition
  • Year 10 – 962 – 30% attrition
  • Year 15 – 368 – 21% attrition

*as of 31-Mar-08

framework for variable selection
Framework for Variable Selection
  • Premorbid history
  • Demographic characteristics of the population
  • Causes and severity of injury
  • Nature of diagnoses
  • Types of treatment/services
  • “Costs” of treatment/services
  • Measurement and prediction of outcomes including impairment, disability and participation
i premorbid history
I. Premorbid History
  • History of TBI
  • Drug Use
  • Alcohol use (NHSDA/BRFSS)
  • Conditions and limitations
  • Psychiatric History
  • Arrests/felony incarcerations
  • Learning/behavior problems
ii demographic characteristics
II. Demographic Characteristics
  • Age
  • Gender
  • Race
  • Marital Status
  • Residence
  • Zip Code
  • Living with
  • Level of education
  • Employment
iii severity of injury
III. Severity of Injury
  • Glasgow Coma Scale Score
  • Revised Trauma Score
  • Duration of unconsciousness
  • Duration of Post Traumatic Amnesia
vi costs of treatment
VI. “Costs” of Treatment
  • Length of stay
  • Charges
  • Payor source
vii measure and predict outcome at follow up
VII. Measure and Predict Outcome at Follow-up

Participation

  • Living with
  • Residence type
  • Marital Status
  • Level of education
  • Alcohol use
  • Drug use
  • Employment
employment variables
Employment Variables
  • employment status
  • hours per week paid competitive employment
  • date of first postinjury competitive employment
  • weeks of paid competitive employment, past year
  • annual earnings
  • receipt of vocational rehabilitation services
  • census occupational category
vii measure and predict outcome at follow up1
VII. Measure and Predict Outcome at Follow-up

Participation (cont.)

  • Transportation
  • Income and source
  • Arrests
  • Psychiatric problems
  • Patient Health Questionnaire (PHQ-9)
  • Satisfaction with Life Scale (SWLS)
  • Participation Assessment (PART)
days in pta
Days in PTA

(Less Severe)

(Extremely Severe)

(Very Severe)

severity of injury
Severity of Injury

summary

  • few have previous TBI (7%)
  • moderate to severe TBI (64%) prevalent
  • average duration LOC = 9.5 days
  • average duration PTA = 26 days
costs of treatment

summary

Costs of Treatment
  • average daily charge is $ 7,779 for acute care and $ 2,085 for inpatient rehabilitation
  • acute care LOS has remained relatively stable and inpatient rehabilitation stays have declined but not consistently
  • 41% have government-sponsored care (Medicaid/Medicare)
disability outcomes

summary

Disability Outcomes
  • most improvement in level of disability and functional ability occurs during inpatient rehabilitation
  • continued improvement is seen

at 1 yr. post-injury

  • disability and functional ability levels plateau 1 to 2 yrs. post-injury