Identifying pre- and posttraumatic brain injury pathways with a multidomain sequence analysis: a retrospective cohort study.

BACKGROUND

Traumatic brain injury (TBI) is a major public health issue, associated with significant mortality and long-term disability. Little is known about the typical trajectories of patients with TBI, particularly before and after injury.

OBJECTIVES

This study aimed to describe care pathways surrounding TBI and to identify the determinants associated with these trajectories, with the ultimate goal of supporting the development of coordinated and optimized care strategies for patients with TBI.

METHODS

A retrospective cohort study was conducted using data from Toulouse University Hospital and the French National Health Data System. People treated for TBI between 2014 and 2018 were identified using ICD-10 codes, and their healthcare trajectories were reconstructed over a period spanning 2 years before and after the injury. A multidomain sequence analysis was conducted across 3 domains: type of care unit, outpatient care type, and mental health status. A multinomial logistic regression model was implemented to analyze the relationship between covariates and care trajectories.

RESULTS

Among the 23 395 people with TBI, 6 distinct care trajectories were identified, 3 per age group. For young individuals aged 10 to 52 years, 4 trajectories ranged from low-complexity and prevention-oriented to high healthcare needs linked with pre-existing mental health vulnerability. Among seniors (aged 53 to 107 years), 3 pathways reflected varying degrees of autonomy loss, reliance on rehabilitation, and psychotropic medication use. Mental health fragility and high hospitalization needs were key discriminants of complex trajectories in both groups. Among the younger group, clustering was largely determined by socioeconomic deprivation, while among the senior group, it was primarily influenced by sex and comorbidity profiles.

CONCLUSION

This study highlights the heterogeneity of TBI care pathways and underscores the need for age-specific and personalized care strategies. Understanding these trajectories can inform early identification of vulnerable people and guide targeted interventions, ultimately improving equity and continuity of care. The methodology also offers valuable applications for managing other complex health conditions.