Prevalence of traumatic brain injury in an offender population: a meta-analysis.

Traumatic brain injury (TBI) can create challenges to managing offenders and to their successful community reentry upon release. In this study, the researchers reviewed relevant articles in Pubmed, PsycInfo, Medline, and EmBase (1983 to 2009) and communicated with other researchers to identify 20 epidemiologic studies that met preestablished inclusion criteria. Random-effects meta- and subgroup analyses were conducted to calculate the prevalence of TBI and the effects of gender, offender type, and definition and method of identifying TBI. The estimated prevalence of TBI in the overall offender population was 60.25 (95% confidence interval: 48.08 to 72.41). A truer estimate of TBI prevalence in offending populations could lead to more appropriate resource allocation, screening, and management of offenders.

The Association of Traumatic Brain Injury, post-traumatic stress disorder, and criminal recidivism.

BACKGROUND: The purpose of the study was to assess the prevalence of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) and to determine whether TBI or PTSD is associated with an increase in general or violent criminal recidivism among a representative sample of released prisoners. In-person interviews were conducted with a stratified random sample of individuals incarcerated with the South Carolina Department of Corrections approximately 90 days prior to the prisoners' releases. In addition to a variety of items and scales, respondents were screened for TBI and were asked whether they had received a current diagnosis of PTSD. Data were merged with arrest data that provided measures of past criminal involvement and indicators of post-release recidivism (arrest). Arrests were coded as "general" for any arrest charge and "violent" for any violent offense charge. RESULTS: Survival analyses indicate that neither TBI nor PTSD predicts time to general recidivism. PTSD (p < 0.01) and age at first arrest (p < 0.01) are significant predictors for violent recidivism and TBI is non-significant at p = 0.09. Results from the negative binomial models indicate that TBI (p < 0.05) and PTSD (p < 0.05) are significantly associated with more post-release violent arrests, but not general arrests. CONCLUSIONS: TBI and PTSD were found to predict violent offending but not general criminal behavior. These findings demonstrate the need for prison officials to identify individuals with a history of TBI and PTSD and to develop appropriate interventions that could be provided during incarceration to reduce the post-release likelihood of violence.

A population-based study of risk of epilepsy after hospitalization for traumatic brain injury.

PURPOSE: This study was undertaken to determine the risk of developing posttraumatic epilepsy (PTE) within 3 years after discharge among a population-based sample of older adolescents and adults hospitalized with traumatic brain injury (TBI) in South Carolina. It also identifies characteristics related to development of PTE within this population. METHODS: A stratified random sample of persons aged 15 and older with TBI was selected from the South Carolina nonfederal hospital discharge dataset for four consecutive years. Medical records of recruits were reviewed, and they participated in up to three yearly follow-up telephone interviews. RESULTS: The cumulative incidence of PTE in the first 3 years after discharge, after adjusting for loss to follow-up, was 4.4 per 100 persons over 3 years for hospitalized mild TBI, 7.6 for moderate, and 13.6 for severe. Those with severe TBI, posttraumatic seizures prior to discharge, and a history of depression were most at risk for PTE. This higher risk group also included persons with three or more chronic medical conditions at discharge. DISCUSSION: These results raise the possibility that although some of the characteristics related to development of PTE are nonmodifiable, other factors, such as depression, might be altered with intervention. Further research into factors associated with developing PTE could lead to risk-reducing treatments.

Impact of pediatric epilepsy: voices from a focus group and implications for public policy change.

Epilepsy affects approximately 0.5-1% of youth, and challenges for them and their families reach far beyond seizures. Quantitative studies have shown that in addition to increased risk for psychosocial difficulties, many experience stigma and barriers to services and resources. As a complement to quantitative analyses, qualitative research further provides unique insight into understanding the impact of epilepsy on youth and families. In the present study, focus groups were held to discuss families' experiences with epilepsy and access to related services. Qualitative analysis revealed three themes highlighting medical, educational, and social challenges of youth with epilepsy. Implications include recommendations for improvements in public awareness and public policy change.

Use and determinants of the methylprednisolone protocol for traumatic spinal cord injury in South Carolina acute care hospitals.

BACKGROUND: The use of methylprednisolone sodium succinate (MPSS) in the treatment of traumatic spinal cord injury was initially reported to enhance recovery in the National Acute Spinal Cord Injury Studies (NASCIS), 1990 and 1997. Controversy led to subsequent research and a 2002 report citing insufficient evidence for MPSS treatment standards or guidelines. Our purpose was to explore emergency department (ED) response to this shifting information by assessing the impact of NASCIS and the 2002 report on MPSS protocols and to study factors associated with MPSS administration. METHODS: Availability of protocols and hospital characteristics were determined by survey of all hospitals with EDs in South Carolina. Protocol copies were obtained and reviewed for accuracy based on NASCIS. Patient hospital discharge information was collected through the state Office of Research and Statistics, and factors associated with receiving MPSS were evaluated using multivariable techniques. RESULTS: Having a protocol was associated with trauma level designation and volume of traumatic spinal cord injury patients per annum, with 100% of Level I trauma facilities having a protocol. Across all trauma levels, 40% of reporting EDs had an MPSS protocol, with 86% of these accurate, and none withdrawn during the study. Patient factors associated with being less likely to receive MPSS were female gender, injury below thoracic level, and treatment in an undesignated trauma center. CONCLUSIONS: Shifting information on the benefit of MPSS did not lead to withdrawal of protocols over the study time period. However, within those hospitals having a protocol, only 32% of eligible patients received MPSS treatment.

A prospective study of health and risk of mortality after spinal cord injury.

OBJECTIVE: To test hypothesized relationships between multiple health parameters and mortality among persons with spinal cord injury (SCI) while controlling for variations in biographical and injury characteristics. DESIGN: Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005. SETTING: A large rehabilitation hospital in the Southeastern United States. PARTICIPANTS: A total of 1389 adults with traumatic SCI, at least 1 year postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome was time from survey to mortality (or time of censoring). Mortality status was determined using the National Death Index and the Social Security Death Index. There were 225 deaths (16.2%) by December 31, 2005. RESULTS: Cox proportional hazards modeling identified several significant health predictors of mortality status, while controlling for biographic and injury factors. Two sets of analyses were conducted--the first identifying the significance of a single variable of interest and the second analysis building a comprehensive model based on an optimal group of variables. Multiple types of health conditions were associated with mortality. The best set of health predictors included probable major depression, surgeries to repair pressure ulcers, fractures and/or amputations, symptoms of infections, and days hospitalized. Inclusion of these variables, along with a general health rating, improved prediction of survival compared with biographic and injury variables alone, because the pseudo R(2) increased from .12 to .18 and the concordance from .730 to .776. CONCLUSIONS: In addition to secondary conditions that have been the traditional focus of prevention efforts (eg, pressure ulcers, urinary tract infections), amputations, fractures, and depressive symptoms were associated with higher risk for mortality; however, further research is needed to identify the association of specific conditions with causes of death and to determine whether interventions can modify these conditions and ultimately improve survival.

Relationships Between Traumatic Brain Injury and Illicit Drug Use and Their Association With Aggression in Inmates.

Extensive interviews of correctional inmates in South Carolina (2009-2010) were conducted under a Center for Disease Control and Prevention (CDC) grant. We evaluated the extent to which early traumatic brain injury (TBI) and subsequent illicit drug abuse may conjointly influence development of aggression, controlling for alcohol use, and whether cognitive or emotional dysregulation mediated this relationship. Early TBI predicted greater severity and earlier onset of drug use, and an earlier age at first use predicted greater aggression regardless of the age of TBI. Emotional dysregulation mediated effects of TBI on aggression. The potential to design more targeted treatments for this susceptible population are discussed.

Childhood adversity, mental health, and violent crime.

BACKGROUND: Little is understood about childhood traumatic brain injury (TBI) and lifetime violent crime perpetration. OBJECTIVES: The purpose was to evaluate TBI before the age of 15 years and other childhood environmental factors, mental health, and lifetime history of committing a violent crime. METHODS: A cross-sectional study of 636 male and female offenders from a southeastern state prison population was conducted using Chi-squared tests, t tests, and logistic regression to determine factors associated with ever committing a violent crime. RESULTS: Committing a violent crime was associated with male gender, younger age, greater childhood sexual abuse (CSA), greater childhood emotional abuse, no TBI by the age of 15 years, and greater neighborhood adversity during childhood. DISCUSSION: Although TBI has been related to violent and nonviolent crime, this study showed that absence of TBI by the age of 15 years was associated with lifetime violent crime when adjusting for CSA, childhood emotional abuse, and neighborhood adversity during childhood. This builds upon neurobehavioral development literature suggesting that CSA and the stress of violence exposure without direct physical victimization may play a more critical role in lifetime violent criminal behavior than childhood TBI. Violence risk reduction must occur during childhood focusing on decreasing adversity, especially violence exposure as a witness as well as a direct victim.

Incidence of sport-related traumatic brain injury and risk factors of severity: a population-based epidemiologic study.

PURPOSE: Few studies of sport-related traumatic brain injury (TBI) are population-based or rely on directly observed data on cause, demographic characteristics, and severity. This study addresses the epidemiology of sport-related TBI in a large population. METHODS: Data on all South Carolina hospital and emergency department encounters for TBI, 1998-2011, were analyzed. Annual incidence rate of sport-related TBI was calculated, and rates were compared across demographic groups. Sport-related TBI severity was modeled as a function of demographic and TBI characteristics using logistic regression. RESULTS: A total of 16,642 individuals with sport-related TBI yielded an average annual incidence rate of 31.5/100,000 population with a steady increase from 19.7 in 1998 to 45.6 in 2011. The most common mechanisms of sport-related TBI were kicked in football (38.1%), followed by fall injuries in sports (20.3%). Incidence rate was greatest in adolescents ages 12-18 (120.6/100,000/persons). Severe sport-related TBI was strongly associated with off-road vehicular sport (odds ratio [OR], 4.73; 95% confidence interval [95% CI], 2.92-7.67); repeated head trauma (OR, 4.36; 95% CI, 3.69-5.15); equestrian sport (OR, 2.73; 95% CI, 1.64-4.51); and falls during sport activities (OR, 2.72; 95% CI, 1.67-4.46). CONCLUSIONS: The high incidence of sport-related TBI in youth, potential for repetitive mild TBI, and its long-term consequences on learning warrants coordinated surveillance activities and population-based outcome studies.

Prevalence of traumatic brain injury in an offender population: a meta-analysis.

Traumatic brain injury (TBI) can create challenges to managing offenders and to their successful community reentry upon release. In this study, the researchers reviewed relevant articles in Pubmed, PsycInfo, Medline, and EmBase (1983 to 2009) and communicated with other researchers to identify 20 epidemiologic studies that met preestablished inclusion criteria. Random-effects meta- and subgroup analyses were conducted to calculate the prevalence of TBI and the effects of gender, offender type, and definition and method of identifying TBI. The estimated prevalence of TBI in the overall offender population was 60.25 (95% confidence interval: 48.08 to 72.41). A truer estimate of TBI prevalence in offending populations could lead to more appropriate resource allocation, screening, and management of offenders.

Association of medically attended traumatic brain injury and in-prison behavioral infractions: a statewide longitudinal study.

This study examined the association between medically attended traumatic brain injury (TBI) and in-prison behavioral infractions in a statewide population by comparing rate ratios of infractions in inmates with and without TBI over an 11.5-year period (16,299 males and 1,270 females). The in-prison behavioral infraction rate was significantly increased in males with TBI compared with no TBI for all infractions (RR = 1.32, 95% CI: 1.12, 1.55), violent infractions (RR = 1.86, 95% CI: 1.54, 2.24), and nonviolent infractions (RR = 1.19, 95% CI: 1.00, 1.41). The violent behavioral infraction rate was significantly increased in females with TBI compared with no TBI (RR = 2.44, 95% CI: 1.45, 4.12). A clearer understanding of inmates with a history of TBI and further examination of the association of TBI and behavioral infractions are needed.

Violence, abuse, and neglect among people with traumatic brain injuries.

BACKGROUND: Violence, abuse, and neglect (VAN) among people with physical and other disabilities has been reported; however, little is known about VAN experiences among people with traumatic brain injuries (TBI). METHODS: Nine people who reported experiencing VAN post-TBI were interviewed for this phenomenological study. The data were analyzed to understand VAN as experienced by those with TBI. RESULTS: Participants detailed many VAN experiences along with contributing factors, barriers in obtaining help, and recommendations for improving preventive and assistance services. CONCLUSIONS: Greater efforts are needed to identify and prevent VAN among people with TBI. Services following VAN must be improved.

Unmet service needs of persons with traumatic brain injury.

OBJECTIVES: Assess unmet needs of persons with traumatic brain injury (TBI) 1 year after hospital discharge; compare perceived need with needs based on deficits (unrecognized need); determine major barriers to services; evaluate association of needs with satisfaction with life. PARTICIPANTS: Representative sample of 1830 community-dwelling persons with TBI aged 15 years and older. MEASURES: Perceived and unrecognized unmet needs, barriers to receiving services, and satisfaction with life as a function of met service needs. RESULTS: 35.2% of participants reported at least 1 unmet need, 51.5% had unrecognized needs, 47% reported at least 1 barrier to receiving help. Receipt of services significantly increased satisfaction with life. CONCLUSIONS: Many persons experiencing TBI report having unmet service needs 1 year after hospital discharge.

Comparison of the Traumatic Brain Injury (TBI) Model Systems national dataset to a population-based cohort of TBI hospitalizations.

OBJECTIVE: To determine whether severity alone accounts for differences observed between a population-based cohort of acute care hospitalizations for traumatic brain injury (TBI) and the Traumatic Brain Injury Model Systems (TBIMS) national dataset. DESIGN: Prospective cohort. SETTING: Acute care hospitals in South Carolina and TBIMS rehabilitation centers. PARTICIPANTS: Subjects enrolled in the TBIMS national dataset and the South Carolina TBI Follow-up Registry (SCTBIFR). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Comparable variables in the 2 datasets included demographic characteristics, etiology of injury, initial Glasgow Coma Scale score, Abbreviated Injury Scale score for the head region derived from International Classification of Diseases codes, presence of computed tomography (CT) abnormalities, acute hospital length of stay, and payer source. RESULTS: As hypothesized, TBIMS participants showed greater initial injury severity, frequency of abnormal CT scans, and longer lengths of acute care hospitalization, explaining over 75% of cohort membership. Counter to a priori hypotheses, when all other factors were held constant, there were also differences in racial and ethnic background and insurance payer source. CONCLUSIONS: Differences between the TBIMS cohort and patients acutely hospitalized with TBI are primarily due to injury severity; however, an additional difference in payer source may need to be taken into account when generalizing findings. Results showed that TBIMS and SCTBIFR datasets are complementary, each having different strengths for understanding factors that impact long-term recovery after TBI. Recommendations are made for methodologic improvements in both data collection for the TBIMS and future outcome surveillance.

A population-based outcomes study of persons hospitalized with traumatic brain injury: operations of the South Carolina Traumatic Brain Injury Follow-up Registry.

OBJECTIVE: To describe the design and operations of the South Carolina Traumatic Brain Injury (TBI) Follow-up Registry. DESIGN: Statewide prospective cohort study. SETTING: State of South Carolina. PARTICIPANTS: 2118 persons discharged from acute care hospitals after experiencing TBI. INTERVENTION: Telephone interviews. MAIN OUTCOME MEASURES: Service needs, alcohol and drug use, psychosocial health, health-related quality of life, functional status, symptoms of TBI, employment, global life satisfaction, and death. RESULTS: Selected initial and 1-year follow-up findings concerning demographic, insurance status, income, and employment factors. CONCLUSIONS: Population-based outcome studies that describe longer term problems associated with TBI, the need for services, and estimated disability could be useful to inform public policy.