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Extension of the Representativeness of the Traumatic Brain Injury Model Systems National Database: 2001 to 2010

Cuthbert, Jeffrey P. MPH, MS; Corrigan, John D. PhD; Whiteneck, Gale G. PhD; Harrison-Felix, Cynthia PhD; Graham, James E. PhD; Bell, Jeneita M. MD, MPH; Coronado, Victor G. MD, MPH

The Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p E15–E27
doi: 10.1097/HTR.0b013e31826da983
Original Articles

Objective: To extend the representativeness of the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) for individuals 16 years and older, admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI) analyses completed by Corrigan and colleagues by comparing this data set to national data for patients admitted to inpatient rehabilitation with identical inclusion criteria that included 3 additional years of data and 2 new demographic variables.

Design: Secondary analysis of existing data sets and extension of previously published analyses.

Setting: Acute inpatient rehabilitation facilities.

Participants: Patients 16 years and older with a primary rehabilitation diagnosis of TBI; the US TBI Rehabilitation population, n = 156 447; and the TBIMS-NDB population, n = 7373.

Interventions: None.

Main Outcome Measures: Demographics, functional status, and length of stay in hospital.

Results: The TBIMS-NDB was largely representative of patients 16 years and older, admitted for rehabilitation in the United States with a primary diagnosis of TBI on or after October 1, 2001, and discharged as of December 31, 2010. The results of the extended analyses were similar to those reported by Corrigan and colleagues. Age accounted for the largest difference between the samples, with the TBIMS-NDB including a smaller proportion of patients 65 years and older than all those admitted for rehabilitation with a primary diagnosis of TBI in the United States. After partitioning each data set at age 65, most distributional differences found between samples were markedly reduced; however, differences in the preinjury vocational status of the employed and rehabilitation lengths of stay between 1 and 9 days remained robust. The subsamples of patients 64 years and younger were found to differ only slightly on all remaining variables, whereas those 65 years and older were found to have meaningful differences in insurance type and age distribution.

Conclusions: These results reconfirm that the TBIMS-NDB is largely representative of patients with TBI receiving inpatient rehabilitation in the United States. Differences between the 2 data sets were found to be stable across the 3 additional years of data, and new differences were limited to those involving newly introduced variables. To use these data for population-based research, it is strongly recommended that statistical adjustment be conducted to account for the lower percentage of patients older than 65 years, inpatient rehabilitation stays less than 10 days, and preinjury vocational status in the TBIMS-NDB.

Research Department, Craig Hospital, Englewood, Colorado (Mr Cuthbert and Drs Whiteneck and Harrison-Felix); Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus (Dr Corrigan); Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston (Dr Graham); and National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Bell and Coronado).

Corresponding Author: Jeffrey P. Cuthbert, MPH MS, Research Department, Craig Hospital, 3425 S Clarkson St, Englewood, CO 80113 (

This research was supported by an intra-agency agreement between the US Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and the National Institute on Disability and Rehabilitation Research (NIDRR), US Department of Education, Office of Special Education and Rehabilitative Services, with supplemental funding to the NIDRR-funded Traumatic Brain Injury (TBI) Model Systems National Data and Statistical Center (grant H133A110006). It was also supported by a TBI Model System Centers grant (H133A070029) from the NIDRR to Ohio State University and by a grant (R24 HD065702) from the National Institutes of Health National Center for Medical Rehabilitation Research

within the National Institute of Child Health and Human Development. This article does not reflect the official policy or opinions of the CDC or the US Department of HHS and does not constitute an endorsement of the individuals or their programs—by CDC, HHS, or other components of the federal government—and none should be inferred. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. The TBI Model Systems National Database is supported by the NIDRR and created and maintained by the TBI Model Systems Centers Program. However, these contents do not necessarily reflect the opinions or views of the TBI Model Systems Centers, the NIDRR, or the US Department of Education.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.