A Population Based Perspective of Children and Youth with Acquired Brain Injury in Ontario, Canada

Acquired brain injury (ABI) includes traumatic (TBI) and non-traumatic brain injury (nTBI). It is a leading cause of death and disability worldwide and can negatively affect the long-term development of children and youth living with an ABI. The objective of this thesis was to address current gaps in pediatric ABI research by (1) establishing the foundation for efforts to reach an appropriate case definition for pediatric TBI; (2) addressing the paucity of information on the health service use of children and youth with nTBI; and (3) expanding current knowledge on children and youth with a brain tumour by including data on individuals with metastatic and non-malignant brain tumours. Population based healthcare administrative data from Ontario, Canada, were used and children and youth with an ABI were identified using International Classification of Diseases Version 10 codes. Results showed that the number and rate, healthcare use, and intentional and mechanism of injury differed significantly when including/excluding 'unspecified injury to the head' diagnostic codes in the case definition for TBI, providing evidence for the importance of accurately interpreting current findings for the TBI population in reference to the case definition. Data also showed that although the rate of nTBI episodes of care was not as high as the rates reported for the TBI population, the health service use among the nTBI population was just as high as the TBI population. This suggests that the pediatric nTBI population puts an increased burden and demand on the healthcare system with currently little data to direct resources and planning. Finally, despite higher rates of malignant brain tumour episodes of care, patients with benign and unspecified brain tumours also use acute care and post-acute care services, indicating that current estimates for brain tumour and associated healthcare use are underestimates. This thesis provided a comprehensive update on children and youth with ABI from a population based perspective that has implications for policy and decision-making, health services planning, and resource allocation for ABI.Ph.D