Prevalence and Risk Factors for Non-Fatal Injuries among Veterans with TBI – Post-Discharge from VA Polytrauma Care
BACKGROUND:
Cognitive, emotional, and/or physical sequelae associated with traumatic brain injury (TBI) may leave individuals especially vulnerable to subsequent injury. VA has established four regional inpatient Polytrauma Rehabilitation Centers (PRCs), in which a majority of patients have sustained TBIs in combination with other physical and psychiatric conditions. This study examined the prevalence of, and potential risk factors for, non-fatal injuries among Veterans with TBI after discharge from VA inpatient polytrauma rehabilitation programs. Using VA data, investigators identified caregivers for Veterans with TBI who had received care from any one of the four PRCs between 9/01 and 2/09. Caregivers (n=504) then completed a survey about themselves and the Veteran for whom they provided care. Measures focused on medically treated new injuries incurred since discharge from the PRC. Investigators also collected data on patient demographics, characteristics of the initial TBI event, and current caregiver-reported health status for both the caregivers and Veterans. Most caregivers were parents (62%) or spouses/romantic partners (32%).
FINDINGS:
- Caregivers reported that nearly one-third (32%) of Veterans discharged from VA Polytrauma Rehabilitation Centers had incurred subsequent, medically treated injuries; most were associated with falls (49%) and motor vehicles (37%).
- Factors associated with Veterans’ increased odds of subsequent injury included poor or fair (compared to excellent, very good, or good) general health and requiring assistance with activities of daily living or instrumental activities of daily living. A number of caregiver-reported ongoing symptoms/health problems among Veterans (e.g., depression, vision loss, hearing loss) were also associated with greater injury odds. Moreover, the odds of subsequent injury increased as the number of reported symptoms/comorbid health problems increased.
- Compared to male Veterans, the small proportion of female Veterans (n=23) had approximately four and a half times the odds of sustaining subsequent injury.
- Caregivers who reported their own health as poor or fair were more likely to report subsequent injuries for Veterans compared to caregivers who reported their own health as excellent, very good, or good. Caregivers with higher than average or average depressive or anxiety symptoms, or lower than average physical functioning scores, also were more likely to report injuries among Veterans compared to caregivers without these symptoms.
LIMITATIONS:
- This study lacked data on environmental or behavioral factors and injury intentionality.
- The cross-sectional nature of the study inhibits any inference regarding causality.
- Investigators relied on proxy information from caregivers about the Veterans’ experiences.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (SDR 07-044 and CDA 08-025). Dr. Carlson was supported by an HSR&D Career Development Award and is part of HSR&D’s Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders.
Carlson K, Meis L, Jensen A, et al. Caregiver Reports of Subsequent Injuries among Veterans with Traumatic Brain Injury after Discharge from Inpatient Polytrauma Rehabilitation Programs. Journal of Head Trauma Rehabilitation January 2012;27(1):14-25.
