Characteristics of Firearm Brain Injury Survivors in the Traumatic Brain Injury Model Systems (TBIMS) National Database: A Comparison of Assault and Self-Inflicted Injury Survivors

Hilary Bertisch; Jason W Krellman; Thomas F Bergquist; Laura E Dreer; Valerie Ellois; Tamara Bushnik

doi:10.1016/j.apmr.2017.04.006

Characteristics of Firearm Brain Injury Survivors in the Traumatic Brain Injury Model Systems (TBIMS) National Database: A Comparison of Assault and Self-Inflicted Injury Survivors

Arch Phys Med Rehabil. 2017 Nov;98(11):2288-2294. doi: 10.1016/j.apmr.2017.04.006. Epub 2017 May 4.

Authors

Hilary Bertisch¹, Jason W Krellman², Thomas F Bergquist³, Laura E Dreer⁴, Valerie Ellois⁵, Tamara Bushnik⁵

Affiliations

¹ Rusk Rehabilitation, New York University School of Medicine, New York, NY. Electronic address: Hilary.bertisch@nyumc.org.
² Department of Neurology, Columbia University Medical Center, New York, NY.
³ Departments of Psychiatry and Psychology, and Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN.
⁴ Departments of Ophthalmology, and Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
⁵ Rusk Rehabilitation, New York University School of Medicine, New York, NY.

PMID: 28478127
DOI: 10.1016/j.apmr.2017.04.006

Abstract

Objective: To characterize and compare subgroups of survivors with assault-related versus self-inflicted traumatic brain injuries (TBIs) via firearms at the time of inpatient rehabilitation and at 1-, 2-, and 5-year follow-up.

Design: Secondary analysis of data from the Traumatic Brain Injury Model Systems National Database (TBIMS NDB), a multicenter, longitudinal cohort study.

Setting: Retrospective analyses of a subset of individuals enrolled in the TBIMS NDB.

Participants: Individuals 16 years and older (N=399; 310 via assault, 89 via self-inflicted injury) with a primary diagnosis of TBI caused by firearm injury enrolled in the TBIMS NDB.

Interventions: Not applicable.

Main outcome measures: Disability Rating Scale, Glasgow Outcome Scale-Extended, sociodemographic variables (sex, age, race, marital status), injury-related/acute care information (posttraumatic amnesia, loss of consciousness, time from injury to acute hospital discharge), and mental health variables (substance use history, psychiatric hospitalizations, suicide history, incarcerations).

Results: Individuals who survived TBI secondary to a firearm injury differed by injury mechanism (assault vs self-inflicted) on critical demographic, injury-related/acute care, and mental health variables at inpatient rehabilitation and across long-term recovery. Groups differed in terms of geographic area, age, ethnicity, education, marital status, admission Glasgow Coma Scale score, and alcohol abuse, suicide attempts, and psychiatric hospitalizations at various time points.

Conclusions: These findings have implications for prevention (eg, mental health programming and access to firearms in targeted areas) and for rehabilitation planning (eg, by incorporating training with coping strategies and implementation of addictions-related services) for firearm-related TBI, based on subtype of injury.

Keywords: Brain injuries, traumatic; Firearms; Rehabilitation; Suicide.

Publication types

Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Factors
Aged
Alcoholism / epidemiology
Brain Injuries, Traumatic / rehabilitation*
Female
Glasgow Coma Scale
Glasgow Outcome Scale
Humans
Longitudinal Studies
Male
Mental Health / statistics & numerical data
Middle Aged
Rehabilitation Centers
Residence Characteristics
Retrospective Studies
Socioeconomic Factors
Suicide, Attempted / statistics & numerical data
Violence / statistics & numerical data
Wounds, Gunshot / rehabilitation*