Prevalence and incidence of traumatic brain injury among incarcerated New York City adolescents

Traumatic Brain Injury (TBI) is a significant public health issue among incarcerated populations and has been associated with behavioral problems during incarceration and may be associated with heightened recidivism. In the NYC jail system, the bureau of Correctional Health Services (CHS) of the New York City Department of Health and Mental Hygiene has undertaken an assessment of the clinical prevalence and incidence of TBI among adolescent patients. In order to assess the prevalence of TBI among adolescents, a validated TBI screening survey was administered to 300 male and 150 female adolescents newly admitted to the NYC Jail system between September 15, 2012 and May 15, 2013. The screening tool comprised 45-items assessing lifetime head injury history and the experience of associated symptoms. Positive history of TBI was defined as head injury involving loss of consciousness for greater than 5 minutes or leading to posttraumatic amnesia. Of 300 males and 150 females interviewed, over 80% and 90%, respectively, reported at least one head injury during their lifetime. TBI was reported by 50% of the adolescent males and 66% of adolescent girls. In order to assess the incidence of new TBI cases in the jail system, CHS altered the injury template contained in the electronic health record (EHR) to include specific questions about blow to the head, loss of consciousness or being dazed or confused. These questions are asked of all patients presented for any injury, representing approximately 1,500 encounters per month, approximately 25% of which are for adolescent patients. Analysis of incidence data is ongoing; however, initial analysis reveals approximately 9% of all adolescents sustain a blow to the head with either loss of consciousness or being dazed/confused during their incarceration. Our early findings suggest that TBI prevalence among adolescents in NYC jail facilities is high and that a significant number of adolescents sustain new TBI while in jail. Patients with severe TBI are often known to the clinical medical and mental health teams; however, the high overall prevalence of TBI suggests the need for a broad intervention. CHS is in the planning stages of programming that will begin to engage patients, security staff and medical providers on the key elements of TBI, including the emotional dysregulation and impaired information processing. These clinical sequelae of TBI can be misinterpreted in the jail setting, with serious consequences, including new TBI.