title: Recent trends in hospitalization and in-hospital mortality  associated with traumatic brain injury in Canada: A nationwide,  population-based study.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide.We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2011 using a nationwide, population based database that is mandatory for all hospitals in Canada.
  
  
  METHODS
  Trends in hospitalization rates for all acute hospital separations in Canada were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression.
  
  
  RESULTS
  Hospitalization rates remained stable for children and young adults but increased considerably among elderly adults (age Q65 years). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p = 0.01), while MVC-related hospitalization rates decreased by 18% (p = 0.03). Elderly adults were most vulnerable to falls and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages, 15Y24 years) were most at risk for MVCs but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends toward increasing age, injury severity, comorbidity, hospital length of stay, and rate of in-hospital mortality.However, multivariate regression showed that odds of death decreased over time after controlling for relevant factors. Injury severity, comorbidity, and advanced age were the most important predictors of in-hospital mortality for TBI inpatients.
  
  
  CONCLUSIONS
  Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities. Although preventive strategies for MVC-related TBI are likely having some effects, there is a critical need for effective fall prevention strategies, especially among elderly adults.
authors.forename: Terence S
authors.initials: TS
authors.lastname: Fu
authors.forename: Rowan
authors.initials: R
authors.lastname: Jing
authors.forename: Steven R
authors.initials: SR
authors.lastname: McFaull
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000401:mortality*; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors