Traumatic brain injury among patients presenting from prison: a cohort study

Abstract

Abstract Over two million people are incarcerated in the United States, where they experience increased illness, injury, and barriers to medical care. Traumatic brain injury (TBI) in the incarcerated population remains underexamined, including prevalence, treatment patterns, and outcomes. We analyzed the 2021–2022 National Trauma Data Bank to identify adult patients (≥ 18 years) with TBI as defined by ICD-10 codes, and incarcerated patients were identified by injury location codes. Propensity score matching (2:1 on age, sex, and race; then with the addition of Glasgow Coma Score and Injury Severity Score) was performed to balance baseline characteristics. Subgroup analysis by TBI severity (mild, moderate, severe range) was conducted. Outcomes included hospital mortality and discharge disposition; interventions received were also recorded. Patients presenting from prison with TBI were younger, more often male, and had fewer comorbidities. They presented with distinct trauma mechanisms, specifically with more frequent assaults and less frequent motor vehicle collisions and firearm injuries. After matching, there was higher mortality among patients presenting from prison with severe TBI (30.9% vs. 25.7%, p  = 0.03), corresponding with a 43% increased risk of mortality once adjusted for age, sex, race, and Injury Severity Score despite similar treatment intensity. Discharge to skilled nursing and acute rehab was significantly less frequent among survivors presenting from prison, with absolute differences of 1.7% and 5.1%, respectively ( p  < 0.001). These findings raise concerns about equity in care delivery and post-acute services for incarcerated individuals with TBI. Structural factors impacting discharge planning in this population warrant further investigation.