Ivins Brian J, Schwab Karen A, Baker Gayle, Warden Deborah L
Defense and Veterans Brain Injury Center, Washington, DC, USA.
Neuroepidemiology. 2006;27(3):154-63. doi: 10.1159/000096127. Epub 2006 Oct 10.
This paper examines 10-year trends in traumatic brain injury (TBI)-related hospitalization rates for active duty US Army personnel in the 1990s. It does this within the context of various factors, including enhanced injury prevention policies and changed hospital admission practices, that may have affected TBI hospitalization rates. It also compares TBI hospitalization rates in the Army to those from an age-comparable segment of the US civilian population over this time period.
Crude (unadjusted) incidence rates for all active duty US Army personnel hospitalized with a TBI diagnosis from fiscal years (FY) 1990 to 1999 were calculated. Once the trends were identified, the percentage change in the overall rate, as well as the rates for different TBI severity levels, and in-hospital deaths from FY1990 and FY1999 were analyzed. Changes in age- and gender-specific rates as well as crude rates for cases with and without other injuries and cases treated in military and civilian hospitals were also analyzed. Rate ratios were used to compare aggregated 5-year TBI hospitalization rates in the Army to rates for civilians 17-49 years of age during the following time periods: 1990-1994 and 1995-1999. The rates used in the comparison were adjusted to control for differences in age and gender.
The overall incidence of TBI-related hospitalization in the Army decreased 75% from FY1990 to FY1999. The rates for all TBI severity levels decreased, but the rate for mild TBI decreased more than the rates for moderate and severe TBI. The rate of in-hospital deaths from TBI also decreased. Rates decreased similarly for males and females, across all age groups, as well as for cases with and without other injuries. TBI rates decreased for Army personnel treated in military hospitals but changed minimally for Army personnel treated in civilian hospitals. The Army's TBI hospitalization rates were generally higher than civilian rates in the early 1990s but by the late 1990s, most of the Army's rates were lower than or equal to the civilian rates.
The incidence of TBI-related hospitalization in the active duty US Army decreased markedly (75%) during the 1990s. As a result, most of the Army's TBI hospitalization rates were lower than civilian rates by the late 1990s. Effective injury prevention and changes in the Army population were two of the factors that likely contributed to the decrease in rates for all TBI severity levels, while changes in hospital admission practices likely contributed to the disproportionate decrease in the Army's rates for mild TBI.
本文研究了20世纪90年代美国现役陆军人员创伤性脑损伤（TBI）相关住院率的10年趋势。这是在包括加强伤害预防政策和改变医院入院做法等各种可能影响TBI住院率的因素背景下进行的。同时，还将这一时期陆军的TBI住院率与美国 civilian 人口中年龄相仿部分的住院率进行了比较。
计算了1990财年至1999财年所有被诊断为TBI并住院的美国现役陆军人员的粗（未调整）发病率。确定趋势后，分析了总体发病率的百分比变化，以及不同TBI严重程度水平的发病率，以及1990财年和1999财年的住院死亡人数。还分析了按年龄和性别划分的发病率变化，以及有和没有其他损伤的病例以及在军事医院和 civilian 医院治疗的病例的粗发病率。率比用于比较陆军汇总的5年TBI住院率与以下时间段内17 - 49岁 civilian 的住院率：1990 - 1994年和1995 - 1999年。比较中使用的率进行了调整，以控制年龄和性别的差异。
从1990财年到1999财年，陆军中与TBI相关的住院总体发病率下降了75%。所有TBI严重程度水平的发病率均下降，但轻度TBI的发病率下降幅度大于中度和重度TBI。TBI导致的住院死亡率也下降了。男性和女性、所有年龄组以及有和没有其他损伤的病例的发病率下降情况相似。在军事医院接受治疗的陆军人员的TBI发病率下降，但在 civilian 医院接受治疗的陆军人员的发病率变化最小。20世纪90年代初，陆军的TBI住院率普遍高于 civilian 率，但到90年代末，陆军的大多数发病率低于或等于 civilian 率。
20世纪90年代，美国现役陆军中与TBI相关的住院发病率显著下降（75%）。因此，到90年代末，陆军的大多数TBI住院率低于 civilian 率。有效的伤害预防和陆军人员构成的变化是所有TBI严重程度水平发病率下降的两个可能因素，而医院入院做法的变化可能导致陆军轻度TBI发病率下降幅度不成比例。
