Category: Brain Injury; Health Services Research; Cross-Cutting
To develop non-hypothesis driven approach for dealing with comorbidity in traumatic brain injury (TBI) and descrive comorbidity preceeding TBI.
Design : An observational population-based study. Data collected five years prior to each TBI event was extracted for each patient and used in the analysis.
Emergency department (ED) or acute care facilities in Ontario, Canada.
Participants (or Animals, Specimens, Cadavers) : Residents of Ontario with universal public health insurance entering ED or acute care facilities between the fiscal years 2007/08 and 2015/16 and random sample of patients entering ED or acute care during the same study period for a reason other than TBI, individually matched to TBI patients by age, sex, income level, and place of residence.
Interventions : N/A
Main Outcome Measure(s) : Differences between the two groups (i.e., TBI and the reference population) within the period of five years preceding a TBI in all ICD-10 CA codes. The Benjamini-Yekutieli multiple testing method was used to obtain a set of codes that were significantly overrepresented in TBI patients compared to matched patients. Data dimensionality and codes reduction were examined using a factor analysis technique.
Results : Of the 58,561 patients (and matched reference patients), 57% were men and 62% were 40 years of age or younger when they had their first TBI. Matched McNemar tests were performed for all 2,600 ICD-10- CA binary variables. The Benjamini-Yekutieli multiple testing method identified 775 significant associations, of which 684 (88.3%) had an OR greater than one. Using the break-points on the scree plots and the interpretability, 43 factors were selected. Factors related to pharmacology-related emergencies, abuse, toxicology, general trauma, environmental/occupational exposures, and Alzheimer's/dementia have a stronger association with TBI.
Conclusions : The data mining procedure developed here allowed not only the validation of previously known risk factors of TBI, but also shed light on the magnitude of associations that previously received little attention, including those related to exposure to occupational hazards, both chemical (i.e., gases, mineral dusts), physical (i.e., extreme temperatures) and mechanical (i.e., trauma); the long-lasting concerns of assault and child abuse at the population level and their links to TBI, and the adverse effect of medications and drugs in the years preceding TBI.
Michael Escobar– Professor, Dalla Lana School of Public Health, Toronto, Ontario
Tatyana Mollayeva– Post Doctoral Fellow, Toronto Rehab-UHN, Toronto, Ontario
Mitchell Sutton– PhD Trainee, University of Toronto, Toronto, Ontario
Vincy Chan– Scientific Associate III, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
Sayantee Jana– Post Doctoral Fellow, University of Toronto, Toronto, Ontario
Angela Colantonio– Professor and Director, University of Toronto, Toronto, Ontario