Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content

Awarded Grant - Acute Care

Nonhospitalized TBI: Michigan Incidence Impact and Cost

FOA Number: CE03-023 - Grants for Acute Care, Rehabilitation and Disability ResearchProject Period: 10/01/03–9/30/06
Application/Grant Number: 1-R49-CE523223-01
Principal Investigator: Ronald F. Maio, DO, MS
Michigan Public Health Institute
Department of Emergency Medicine
University of Michigan Health System
300 NIB 2D06, Box 0437
Ann Arbor, MI 48109-0437
Phone: 734-936-1724
Fax: 734-936-2706


Approximately 1.5 million Americans each year are involved in motor vehicle crashes, falls, recreation activities, and violence-related events that result in a traumatic brain injury (TBI). Each year nationwide, more than 50,000 people die because of TBI and 5.3 million (2% of the population) live with a disability resulting from TBI. Despite the increasing rate of hospitalization for TBI, there are very few emergency department (ED) based studies of TBI. Mild TBI (MTBI) is recognized as an important health problem, but there is inadequate data to determine accurately the extent of MTBI among non-hospitalized injuries and the outcomes associated with MTBI among non-hospitalized patients.

This research will determine the incidence of, and outcomes associated with, non-hospitalized mild TBI (MTBI). The study will use three sources of information: a unique statewide ED injury surveillance database, statewide claims data, and an ED-based prospective cohort study of minor-injury patients.

Primary aims:

  1. Determine the prevalence and characteristics of non-hospitalized MTBI patients;
  2. Determine the outcomes associated with non-hospitalized MTBI, in particular post-concussive syndrome (PCS);
  3. Compare the level of agreement between case identification of non-hospitalized MTBI using surveillance ICD-9-CM criteria and case identification protocols in the ED cohort study.

Secondary aims:

  1. Determine the costs and services associated with non-hospitalized MTBI;
  2. Compare hospitalized and non-hospitalized TBI cases on demographic variables and the nature and severity of injuries.
The project will be conducted using two broad study designs: (1) analysis of secondary data using Michigan ED data and Medicaid and private insurers’ data systems to determine the incidence, nature, and causes of MTBI, costs incurred, and services used by non-hospitalized TBI individuals; and (2) a panel study of a sample of adults treated for TBI at an ED, subsequently discharged, and surveyed four times within a period of 1 year after their injury event. Self-reported survey measures will include demographics, health status, PCS and cognitive symptoms, and an alcohol-related assessment.