Adolescent health brief
Traumatic Brain Injury Among Newly Admitted Adolescents in the New York City Jail System

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Abstract

Purpose

Relatively little is known about the prevalence of traumatic brain injury (TBI) among adolescents who come into contact with the criminal justice system.

Methods

We undertook screening for TBI among newly admitted adolescents in the New York City jail system using a validated TBI screening tool. A convenience sample of 300 male and 84 female screenings was examined.

Results

Screening revealed that 50% of male and 49% of female adolescents enter jail with a history of TBI. Incidence of TBI was assessed using patient health records, and revealed an incidence of 3,107 TBI per 100,000 person-years.

Conclusions

Elevated prevalence and incidence of TBI among incarcerated adolescents may relate to criminal justice involvement as well as friction in jail. Given the large representation of violence as a cause of TBI among our patients, we have begun focus groups with them to elicit meaningful strategies for living with and avoiding TBI.

Section snippets

Methods

Traumatic brain injury prevalence was determined by screening newly arrived adolescent inmates using the Traumatic Brain Injury Questionnaire. The screening queries patients about head injury history, with circumstances as symptoms graded by frequency and severity, yielding a Total Symptom Severity Scale (TSSS) and a Total Symptom Frequency Scale (TSFS) [5].

Over 12 months, a convenience sample of newly admitted, English-speaking adolescents (300 male and 84 female) were screened. Other data

Analysis

Head injuries were categorized by group: (1) no head injury history or only one minimal/suspected injury; (2) multiple minimal or suspected head injuries but no loss of consciousness or posttraumatic amnesia; and (3) at least one injury with loss of consciousness and/or posttraumatic amnesia, which is the accepted definition of TBI. This analysis represented routine public health surveillance and was thus exempt from institutional review board oversight.

Results

At least one head injury was reported by 259 (67.4%) of the 384 screened inmates. The most frequent injury circumstances were assault (55.5%) and fall-related (41%). A total of 125 inmates (32.5%) were in group 1, 68 (17.3%) in group 2, and 191 (49.7%) in group 3 (Table 1). Group 3 patients used significantly more in-jail mental health services and scored significantly higher on severity and frequency scales. Females in group 3 were significantly more likely to use mental health services (75.0%

Discussion

Our observation that approximately half of adolescents arriving in the New York City jail system have a history of TBI is well in excess of 32% reported elsewhere [6]. We observed that female adolescents in group 1 had significantly higher TSSS scores than males, which could reflect differences in the nature of their injuries or some contribution of non-TBI factors such as mental health concerns. The incidence of TBI in our setting appears to be significantly higher than widely reported

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