Towards a disability-oriented epidemiology of traumatic brain injury

The aim of this study was to investigate the value of using a disability-oriented approach to the epidemiology of traumatic brain injury (TBI) in order to improve health administration by preventing long-term sequelae. The epidemiology of disease was established by a registration system of inpatients which covers more than 99% of all hospital admissions in The Netherlands. Some international differences and national trends are discussed. The disability-related epidemiology was investigated by means of structured interviews, 3-7 years after the injury, in a clustered sample of 51 patients with major TBI according to the ICD-9-CM. The survey included evaluation scales such as the Sickness Impact Profile, the Barthel Index, and a Disability Rating Questionnaire. Concerning the disease-related epidemiological data, the overwhelming majority of all TBI patients went home, which suggests good recovery. Nevertheless, the disability-oriented research revealed long-term situational, cognitive and behavioural disabilities in at least 67% of the major-TBI population, whereas only 10% received any rehabilitation services at all after the acute-care period. It is concluded that preventive measures and a comprehensive service for brain injury survivors should be based both on disease and disability-oriented data.