Trends in Hospitalization Associated With Traumatic Brain Injury in a Publicly Insured Population, 1992–2002

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability in developed countries. We document trends in TBI-related hospitalizations in Ontario, Canada, between April 1992 and March 2002, focusing on relationships between inpatient hospitalization rates, age, sex, cause of injury, severity level, and in-hospital mortality. METHODS: Information on all acute hospital separations in Ontario with a diagnosis of TBI was analyzed using logistic regression. RESULTS: Hospitalization rates fell steeply among children and young adults but remained stable among adults aged 66 and older. The proportion of TBI hospitalizations with mild injuries decreased from 75% to 54%, whereas the proportion with moderate injuries increased from 19% to 37%. Adjusting for other risk factors, in-hospital deaths were higher for injuries because of motor vehicle crashes than those because of falls. In-hospital death rates were stable for patients with moderate or severe injuries, but increased over time among those whose injuries were classified as mild, suggesting a trend toward more serious injury within the "mild" classification. CONCLUSIONS: Hospitalizations for TBI involve fewer mild injuries over time and are highest in the oldest segment of the population.