Longitudinal healthcare use after pediatric brain injury: A population-based birth cohort study
Notice bibliographique
Résumé
BACKGROUND: Traumatic brain injury is a chronic disease with lifelong consequences. In children, it can affect developmental milestones. Longitudinal data on brain injury and long-term healthcare use is limited, with lack of clarity on social determinants of health and its effects on healthcare use. This study explores rates of healthcare use, from birth, and up to 10 years after a childhood traumatic brain injury-related healthcare visit. METHODS AND FINDINGS: This study uses a population-based birth cohort of individuals born between April 1, 2002 and March 31, 2020 from Ontario, Canada. A case cohort (TBI cohort) was created using a sample of individuals who had at least one traumatic brain injury-related healthcare visit between the ages of 0 and 4 years, inclusive (n = 26,988). Controls were generated from a sample of individuals who did not have any traumatic brain injury-related healthcare visit during the study period (n = 193,253 for emergency department visits and hospitalizations, and n = 19,313 for primary care physician visits). The primary outcome is rates of primary care physician visits, emergency department visits, and hospitalizations for each year prior to and up to 10 years after the index traumatic brain injury-related healthcare visit, calculated using standard life table methods. Rates and 95% confidence intervals were further calculated and stratified by rurality of residence, and the following Ontario Marginalization Index metrics: neighbourhood income quintile and neighbourhood racialized and newcomer populations. Rates of healthcare use remained consistently higher in the TBI cohort compared to controls both prior to and after the index TBI-related healthcare visit. Rates also varied across social determinants of health. Overall, rates were higher in males compared to females across all healthcare settings. Rates of primary care physician visits were higher among those living in urban (vs. rural) settings. However, rates of emergency department visits were higher among those living in rural (vs. urban) settings. Rates of emergency department visits and hospitalizations were higher among those living in the lowest (vs. highest) income quintile neighbourhoods. Rates of primary care physician visits were higher among those living in areas with the most (vs. least) racialized and newcomer populations. However, rates of emergency department and hospitalizations were higher among those living in areas with the least (vs. most) racialized and newcomer populations. This study is limited to change in rates of healthcare use over time and does not quantify the magnitude of these changes. CONCLUSIONS: Research on longitudinal healthcare use is needed to explore the causes of sustained and increased healthcare use post-injury, to inform opportunities for targeted health and social care interventions. Findings also suggest that a lifespan perspective is critical to understand how early life events can impact post-injury outcome.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».