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Traumatic brain injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain. Every year, millions of people in the U.S. suffer brain injuries. The worst injuries can lead to permanent brain damage or death. Half of all TBIs are from motor vehicle accidents. Symptoms of a TBI may not appear until days or weeks following the injury. A concussion is the mildest type. It can cause a headache or neck pain, nausea, ringing in the ears, dizziness, and tiredness.

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Centers for Disease Control and Prevention

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Abstract

Problem/Condition: Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007.

Reporting Period: 2007 and 2013.

Description of System: State-based administrative health care data were used to calculate estimates of TBI-related ED visits and hospitalizations by principal mechanism of injury, age group, sex, and injury intent. Categories of injury intent included unintentional (motor-vehicle crashes, falls, being struck by or against an object, mechanism unspecified), intentional (self-harm and assault/homicide), and undetermined intent. These health records come from the Healthcare Cost and Utilization Project's National Emergency Department Sample and National Sample. TBI-related death analyses used CDC multiple-cause-of-death public-use data files, which contain death certificate data from all 50 states and the District of Columbia.

Results: In 2013, a total of approximately 2.8 million TBI-related ED visits, hospitalizations, and deaths (TBI-EDHDs) occurred in the United States. This consisted of approximately 2.5 million TBI-related ED visits, approximately 282,000 TBI-related hospitalizations, and approximately 56,000 TBI-related deaths. TBIs were diagnosed in nearly 2.8 million (1.9%) of the approximately 149 million total injury- and noninjury-related EDHDs that occurred in the United States during 2013. Rates of TBI-EDHDs varied by age, with the highest rates observed among persons aged ≥75 years (2,232.2 per 100,000 population), 0-4 years (1,591.5), and 15-24 years (1,080.7). Overall, males had higher age-adjusted rates of TBI-EDHDs (959.0) compared with females (810.8) and the most common principal mechanisms of injury for all age groups included falls (413.2, age-adjusted), being struck by or against an object (142.1, age-adjusted), and motor-vehicle crashes (121.7, age-adjusted). The age-adjusted rate of ED visits was higher in 2013 (787.1) versus 2007 (534.4), with fall-related TBIs among persons aged ≥75 years accounting for 17.9% of the increase in the number of TBI-related ED visits. The number and rate of TBI-related hospitalizations also increased among persons aged ≥75 years (from 356.9 in 2007 to 454.4 in 2013), primarily because of falls. Whereas motor-vehicle crashes were the leading cause of TBI-related deaths in 2007 in both number and rate, in 2013, intentional self-harm was the leading cause in number and rate. The overall age-adjusted rate of TBI-related deaths for all ages decreased from 17.9 in 2007 to 17.0 in 2013; however, age-adjusted TBI-related death rates attributable to falls increased from 3.8 in 2007 to 4.5 in 2013, primarily among older adults. Although the age-adjusted rate of TBI-related deaths attributable to motor-vehicle crashes decreased from 5.0 in 2007 to 3.4 in 2013, the age-adjusted rate of TBI-related ED visits attributable to motor-vehicle crashes increased from 83.8 in 2007 to 99.5 in 2013. The age-adjusted rate of TBI-related hospitalizations attributable to motor-vehicle crashes decreased from 23.5 in 2007 to 18.8 in 2013.

Interpretation: Progress has been made to prevent motor-vehicle crashes, resulting in a decrease in the number of TBI-related hospitalizations and deaths from 2007 to 2013. However, during the same time, the number and rate of older adult fall-related TBIs have increased substantially. Although considerable public interest has focused on sports-related concussion in youth, the findings in this report suggest that TBIs attributable to older adult falls, many of which result in hospitalization and death, should receive public health attention.

Public Health Actions: The increase in the number of fall-related TBIs in older adults suggests an urgent need to enhance fall-prevention efforts in that population. Multiple effective interventions have been identified, and CDC has developed the STEADI initiative (Stopping Elderly Accidents Deaths and Injuries) as a comprehensive strategy that incorporates empirically supported clinical guidelines and scientifically tested interventions to help primary care providers address their patients' fall risk through the identification of modifiable risk factors and implementation of effective interventions (e.g., exercise, medication management, and Vitamin D supplementation).

Introduction

CDC conducts surveillance of traumatic brain injury (TBI) to understand the public health burden, to monitor trends, and to identify groups at greatest risk for TBI. TBI is a major cause of mortality in the United States, contributing to approximately 30% of all injury-related deaths ( 1). The burden on the health care system is also substantial; in 2010, approximately 2.5 million emergency department (ED) visits, hospitalizations, or deaths were associated with TBI ( 2). From 2001 to 2010, the rates of ED visits increased by 70%, and rates of hospitalization and death increased by 11% and 7%, respectively ( 2).

Historically, CDC's national estimates of TBI-related hospitalizations and ED visits have been based on data from two sources: the National Hospital Discharge Survey (NHDS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), respectively. These databases have been useful in identifying broad groups affected by TBI and the most common principal mechanisms of injury resulting in TBI. However, the relatively small sample sizes of these databases have not allowed for the calculation of stable annual estimates by subgroups of interest, such as estimates stratified by both age group and principal mechanism of injury. As a result, pooled years of data were required to achieve stability; for example, data published by CDC in 2010 included estimates of TBI-related medical encounters from NHDS and NHAMCS that were pooled for 2002-2006. This limits the ability of researchers to document changes in TBI incidence over time, especially for subgroups of particular risk (e.g., falls among children and older adults and sports-related TBIs among youth). To improve TBI estimation, CDC identified alternative databases that were large enough to provide annual estimates of TBI within subgroups. CDC uses the Healthcare Cost and Utilization Project (HCUP) databases to estimate the incidence of TBI in the United States ( 3- 5). The findings in this report can be used by public health officials to understand trends in TBI-related medical events (e.g., emergency department visits, hospitalizations and deaths) and to identify priority areas for prevention programs.

Methods

To estimate the incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths (TBI-EDHDs) during 2013 compared to 2007, CDC analyzed the latest data from two HCUP databases and the National Vital Statistics System (NVSS). The findings are reported by principal mechanism of injury, age group, sex, and medical event type (i.e., ED visits, hospitalizations, deaths) for 2013. In addition, estimates from 2007 and 2013 were compared to describe changes in TBI incidence since CDC's most recent detailed report examining data during 2002-2006 ( 1). Traumatic brain injury-related deaths were analyzed using the multiple-cause-of-death files from the 2007 and 2013 NVSS.

Data Sources

The HCUP Nationwide Emergency Department Sample (NEDS) and HCUP National Inpatient Sample (NIS) are visit-based databases that contain sample sizes large enough to provide stable annual estimates of TBI for subgroups ( 3, 4). Previous work has found that the frequencies of TBI-related hospitalizations and ED visits in these HCUP databases are comparable to those observed in NHDS and NHAMCS ( 5). NVSS includes data for all deaths registered in all 50 U.S. states and the District of Columbia ( 6).

Data used to describe TBI-related ED visits were obtained from the 2007 and 2013 NEDS. NEDS is the largest all-payer ED record database in the United States; in 2013, it contained 29,581,718 records representing 134,869,015 ED visits nationally ( 4). NEDS is designed to represent a 20% stratified sample of U.S. hospital-based EDs with records drawn from non-Federal, short-term, general, and other specialty hospitals from participating states (30 states in 2013) ( 4).

TBI-related inpatient hospitalizations were analyzed using data from the 2007 and 2013 NIS. Similar to NEDS, NIS is the largest all-payer inpatient hospitalization database; in 2013, it contained data from 7,119,563 records, representing 35,597,792 hospital discharges nationally ( 3). Throughout the report, NIS discharges are referred to as hospitalizations. The 2013 data represent a 20% sample of hospital discharges from community hospitals, excluding rehabilitation and long-term acute care facilities ( 3).

Records from both NEDS and NIS do not include individual patient identifiers and, unlike the mortality data, might contain more than one record per person (i.e., multiple ED visits for the same injury or multiple medical event types for different injuries). Certain records were excluded to reduce the possibility of counting multiple encounters for the same injury. In-hospital deaths were excluded from the hospitalization counts (because these would be included in the mortality data), as were hospital transfers and hospital admissions that occurred directly from the ED (because each would be included in the hospitalization data).

Surveillance Definition

For TBI-related ED visits and hospitalizations, cases were identified using codes from the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) using an established definition ( 7). Records were included and classified as TBI-related if any of the following ICD-9-CM codes were included in the record as a diagnosis code, regardless of its position (i.e., both primary and secondary diagnoses were included):

800: fracture of vault of skull;

801: fracture of the base of skull;

803: other and unqualified skull fractures;

804: multiple fractures involving skull or face with other bones;

850: concussion;

851: cerebral laceration and contusion;

852: subarachnoid, subdural, and extradural hemorrhage, following injury;

853: other and unspecified intracranial hemorrhage following injury;

854.0, 854.1: intracranial injury of other and unspecified nature;

950.1-950.3: injury to the optic nerve and pathways;

959.01: head injury, unspecified; and

995.55: shaken infant syndrome.

For TBI-related deaths, cases were included if the record contained a TBI-related code from the International Classification Diseases, Tenth Revision (ICD-10) in any position of the NVSS mortality record. This coding definition has been used previously in the identification of TBI-related mortality records ( 1). These codes included:

S01: open wound of the head;

S02.0, S02.1, S02.3, S02.7-S02.9: fracture of the skull and facial bones;

S04.0: injury to optic nerve and pathways;

S06: intracranial injury;

S07.0, S07.1, S07.8, S07.9: crushing injury of head;

S09.7-S09.9: other unspecified injuries of head;

T01.0: open wounds involving head with neck;

T02.0: fractures involving head with neck;

T04.0: crushing injuries involving head with neck;

T06.0: injuries of brain and cranial nerves with injuries of nerves and spinal cord at neck level; and

T90.1, T90.2, T90.4, T90.5, T90.8, T90.9: sequelae of injuries of head.

Variables

Data were stratified by age, sex, principal mechanism of injury, and injury intent. Age groups included ages 0-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years. Principal mechanisms of injury included motor-vehicle crashes, falls, being struck by or against an object, mechanism unspecified, and other. Categories of injury intent included unintentional (motor-vehicle crashes, falls, being struck by or against an object, mechanism unspecified), intentional (self-harm and assault/homicide), and undetermined intent. Estimates of intentional self-harm were suppressed for the 0-4 and 5-14 year age groups because it is unclear whether children aged <10 years are truly able to form suicidal intent ( 8). For ED visits and hospitalizations, these categories were based on CDC's recommended framework for grouping external cause-of-injury codes (E-codes) using ICD-9-CM ( 9). Up to four E-codes can be recorded per ED visit or hospitalization in NEDS or NIS. The first-listed E-code should correspond to the most serious diagnosis assigned ( 10). Therefore, only the first-listed valid E-code was used in this analysis, and this assigned code was assumed to be the principal mechanism of injury for the TBI. Valid injury mechanism E-codes (E800-E966 and E968-E999) are those that are correct in syntax (i.e., they exist as stated within ICD-9-CM) and correspond to a principal mechanism of injury rather than an activity (code E000), place of occurrence (E001-E030), or perpetrator of abuse (E967). Principal mechanism of injury and injury intent for TBI-related deaths were categorized on the basis of the CDC-recommended external cause of injury mortality matrix for ICD-10 ( 11).

Statistical Analysis

For ED visits and hospitalizations, data were weighted to provide national estimates of annual numbers and rates per 100,000 population. These rates and 95% confidence intervals around each rate were based on U.S. bridged-race population estimates of the resident population released and maintained by CDC for individual years ( 12). Age-adjusted rates were standardized to the U.S. census population estimates for 2000 by the direct method ( 1). Estimates were considered unreliable and not reported if the relative standard error was >30% or the standard error = 0. Chi-square or t-tests were used to analyze between-group differences for number and rates, respectively, of TBI-related ED visits, hospitalizations, and deaths. Only selected comparisons were tested for statistical significance. Differences with p values <0.05 were considered statistically significant. All statistical analyses were performed using SAS Systems for Windows, version 9.3 (SAS Institute, Cary, North Carolina).

The sampling frame for NIS data changed in 2012. Before 2012, NIS data were derived from a sample of hospitals with all discharges included. Beginning in 2012, NIS data were based on a sample of discharges from all NIS-participating hospitals. Revised weights for trend analyses using 2011 NIS data and earlier were used to calculate estimates comparable to the new design in accordance with NIS guidance ( 13).

Results

In 2013, a total of 2.8 million TBI-EDHDs occurred in the United States ( Table 1). This consisted of approximately 2.5 million TBI-related ED visits, approximately 282,000 TBI-related hospitalizations, and approximately 56,000 TBI-related deaths. Of the 149 million total injury and noninjury-related EDHDs that occurred in the United States in 2013, TBIs were diagnosed in 1.9% of these. The proportion of TBI-related injuries accounted for approximately one of every 50 ED visits (2.2%). TBI-related deaths accounted for 2.2% of all deaths in the United States.

TBI-Related ED Visits, Hospitalizations, and Deaths by Age Group

Rates of TBI-EDHD varied by age, with the highest rates observed among those aged ≥75 years (2,232.2 per 100,000 population), 0-4 years (1,591.5), and 15-24 years (1,080.7) ( Table 2). With respect to TBI-related ED visits only, the age groups with the highest rates were those aged ≥75 years (1,701.7), 0-4 years (1,541.1), and 15-24 years (1,001.9). Rates of TBI-related hospitalizations and deaths were highest among the oldest age groups. For hospitalizations, the age groups with the highest rates were those aged ≥75 years (454.4), 65-74 years (139.4), and 55-64 years (86.0). The same pattern was observed for TBI-related deaths with the highest rates found among those aged ≥75 years (76.1), 65-74 years (24.3), and 55-64 years (18.8). In terms of overall numbers, persons aged 15-24 years accounted for 17.9% of all TBI-related ED visits, more than any other age group. Those aged ≥75 years comprised the largest proportion of both TBI-related hospitalizations (31.4%) and deaths (26.5%).

TBI-Related ED Visits, Hospitalizations, and Deaths by Age Group and Principal Mechanism of Injury

Rates of TBI-EDHDs varied by principal mechanism of injury, and by age group within principal mechanism of injury ( Table 3). Overall, the most common principal mechanisms of injury were falls (413.2 per 100,000 population, age-adjusted), being struck by or against an object (142.1, age-adjusted), and motor-vehicle crashes (121.7, age-adjusted). These principal mechanisms represented 47.2%, 15.4%, and 13.7% of all TBI-EDHDs, respectively. Examining each principal mechanism by age group reveals a different pattern. Those aged ≥75 years had the highest rate of fall-related TBI-EDHDs (1,859.0), followed by 0-4 years (1,119.3), and 65-74 years (539.8). For TBI-EDHDs attributable to being struck by or against an object, the age groups with the highest rate include those aged 5-14 years (291.9), 0-4 years (262.7), and 15-24 years (243.3). Finally, for TBI-EDHDs attributable to motor-vehicle crashes, those aged 15-24 years (258.3), 25-34 years (182.9), and 35-44 years (126.5) had the highest rates.

TBI-Related ED Visits, Hospitalizations, and Deaths by Sex and Principal Mechanism of Injury

Differences in age-adjusted rates were found for each principal mechanism when comparing rates of TBI-EDHDs by sex ( Table 4). Overall, males had higher age-adjusted rates of TBI-EDHDs (959.0 per 100,000 population) compared with females (810.8. Males had higher age-adjusted rates of being struck by or against an object compared with females (167.3 versus 115.6), a higher age-adjusted rate of motor-vehicle crash-related TBI-EDHDs (128.2 versus 115.5), a more than fivefold higher age-adjusted rate of intentional self-harm-related TBI-EDHDs (11.7 versus 2.3), a higher age-adjusted rate of assault-related TBI-EDHDs (96.0 versus 54.8) (Table 4). Females had a significantly higher age-adjusted rate of fall-related TBI-EDHDs compared to men (417.7 versus 400.7).

Comparison of TBI-Related ED Visits Between 2007 and 2013 by Age Group and Principal Mechanism of Injury

Age-adjusted rates of TBI-related ED visits increased from 534.4 per 100,000 in 2007 to 787.1 in 2013 (Table 2). Further, this increase in TBI-related ED visit rates has occurred for nearly all of the major principal mechanism categories: a 65% increase for falls (from 222.6 per 100,000 to 366.5, age-adjusted); a 55% increase in being struck by or against an object (from 90.3 to 139.8, age-adjusted); a 75% increase for TBIs as a result of intentional self-harm (from 0.4 to 0.7, age-adjusted); a 20% increase for assaults (from 56.8 to 68.2, age-adjusted); and a 19% increase for motor-vehicle crashes (from 83.8 to 99.5, age-adjusted) ( Table 5).

The number of TBI-related ED visits increased from approximately 1.6 million in 2007 to approximately 2.5 million in 2013, representing an increase of more than 50%, or an increase of more than 850,000 ED visits (Table 2). The key contributors to the increase are falls (accounting for 57.3% of the increase); being struck by or against an object (accounting for 18.2% of the increase); and motor-vehicle crashes (accounting for 7.0% of the increase). With respect to both principal mechanism and age, the key contributors to the increase are fall-related TBIs among those aged ≥75 years (accounting for 17.9% of the increase), aged 65-74 years (accounting for 7.7% of the increase), aged 55-64 years (accounting for 6.7% of the increase), and aged 0-4 years (accounting for 6.1% of the increase) and being struck by or against an object among those aged 5-14 years (accounting for 5.7% of the increase) and 15-24 years (accounting for 4.2% of the increase).

Comparison of TBI-Related Hospitalizations Between 2007 and 2013 by Age Group and Principal Mechanism of Injury

Approximately 75% of TBI-related hospitalizations in 2013 were attributable to two principal mechanisms: falls (50.4%) and motor-vehicle crashes (21.5%) ( Table 6). Overall, the total number of TBI-related hospitalizations in 2013 (281,555) was similar to the number of TBI-related hospitalizations in 2007 (267,350) and rates of TBI-related hospitalizations remained nearly the same (Table 2). The age-adjusted rate of TBI-related hospitalizations attributable to motor-vehicle crashes decreased from 2007 to 2013 (from 23.5 to 18.8 per 100,000) (Table 6). In addition, the age-adjusted rate of TBI-related hospitalizations attributable to falls increased from 33.9 in 2007 to 42.2 in 2013.

Age was an important factor contributing to the TBI-related hospitalization rate change from 2007 to 2013. The overall decrease in rates of TBI-related hospitalizations attributable to motor-vehicle crashes was evidenced most prominently among those aged 15-24 years as the rate decreased from 47.3 in 2007 to 31.8 in 2013 (Table 6). The overall increase in rates of TBI-related hospitalizations attributable to falls was observed most prominently among those aged ≥75 years (from 257.3 in 2007 to 354.8 in 2013).

Comparison of TBI-Related Deaths Between 2007 and 2013 by Age Group and Principal Mechanism of Injury

Overall, the number of TBI-related deaths increased from 54,699 in 2007 to 55,920 in 2013 (Table 2). However, age-adjusted rates of TBI-related deaths decreased slightly during that period (from 17.9 to 17.0 per 100,000). This decrease is largely attributable to an overall decrease in the age-adjusted rate of TBI-related deaths attributable to motor-vehicle crashes (5.0 in 2007 to 3.4 in 2013) ( Table 7). Despite the overall decrease in rates, there were increases in the age-adjusted rate of TBI-related deaths attributable to falls (from 3.8 in 2007 to 4.5 in 2013) and intentional self-harm (from 4.8 in 2007 to 5.6 in 2013). Whereas motor-vehicle crashes were the leading cause of TBI-related death in 2007, in both number and rate, intentional self-harm was the leading cause, in number and rate, in 2013. Increases between 2007 and 2013 in the number of TBI-related deaths attributable to self-harm were found among all age groups examined (i.e., those aged ≥15 years). In 2013, of TBI-related deaths attributable to self-harm, 86.9% were among males; in 96.9% of these cases, a firearm was the principal mechanism (data not shown). Although leading causes of TBI-related deaths for all other age groups are either falls, motor-vehicle crashes, or unintentional self-harm, the leading cause among those aged 0-4 years in 2007 and 2013 was assault/homicide (Table 7).

The overall decrease in the rate of TBI-related deaths attributable to motor-vehicle crashes was found among all age groups, with the most pronounced decrease being among those aged 15-24 years (from 10.0 in 2007 to 5.7 in 2013). The increased rate of TBI-related deaths attributable to falls was not evenly spread among all ages as those aged ≥75 years had the largest increase (from 39.7 in 2007 to 50.3 in 2013).

Discussion

In 2013, approximately 2.8 million TBI-EDHDs occurred in the United States. Most were TBI-related ED visits (87.9%), and only 2.0% of the total were TBI-related deaths. Males continue to have higher rates of TBI-EDHDs compared with females ( 1, 14). Although the total number of TBI-EDHDs has increased over time, the increases are not uniform across all age groups or principal mechanisms of injury, and this suggests priority areas for TBI-related prevention.

Several hypotheses might explain the increase in TBI-EDHDs over time. First, heightened public awareness about sports-related concussions might have translated to greater public concern about the effects of TBI generally, leading people of all ages to more readily seek care. Second, heightened awareness among health care providers, and the broader dissemination of validated assessment tools, might have resulted in more TBI diagnoses. Although increases among youth were found for TBI-related ED visits, there were significant increases in the number of ED visits, hospitalizations, and deaths attributable to TBIs resulting from older adult falls. This across-the-board increase over a relatively short time, suggests the need to address preventing and reducing the number of older adult falls resulting in TBI.

The highest rates of TBI-EDHDs were among the oldest or youngest age groups. TBIs in these age groups are notable for several reasons. In children aged <7 years, TBIs can impair neurologic development and the ability to meet developmental milestones ( 15). Impaired development might lead to further challenges as a child ages, such as declines in academic functioning and psychosocial sequelae such as emotional and behavioral disorders (e.g., depression or attention-deficit hyperactivity disorder) ( 16- 19). In older adults, TBIs are associated more often with hospitalization and death. Cognitive and physical reserve are diminished at older ages, so TBIs might have a greater impact on daily living. TBIs in older adults are more likely to lead to hospitalization and these hospitalizations can be complicated by the presence of comorbidities. Furthermore, more frequent use of anticoagulants among older adults can result in a greater likelihood of secondary effects because of an increased likelihood of intracranial hemorrhage ( 20, 21).

The most common principal mechanisms of injury for TBI-EDHDs were falls, being struck by or against an object, and motor-vehicle crashes. Although these three principal mechanisms accounted for approximately 70% of all TBI-EDHDs, particular age groups were disproportionally affected by specific principal mechanisms, similar to previous studies ( 1, 14, 22, 23). Approximately half of all fall-related TBI-EDHDs occurred among those aged 0-4 years and ≥75 years. Codes defining whether a TBI was fall-related are heterogeneous. In addition to falls attributable to tripping and slipping, the codes also capture falls on stairs or from ladders, falls from one level to another (e.g., from a bed or chair), and falls into openings such as swimming pools. This analysis did not examine the individual contribution of each fall-related code. Future analyses could examine these individual codes to delineate better how activities leading to fall-related TBI vary by age group.

Certain prevention strategies have been identified for older adult falls, many of which have been demonstrated in randomized controlled trials to be effective ( 24). These include multicomponent physical exercise programs, Tai chi, Vitamin D supplementation (which might be effective among those who are Vitamin D deficient), surgical interventions (e.g., pacemakers and cataract surgery where indicated), and strategies to reduce home hazards (e.g., increased lighting and removal of tripping hazards). CDC has developed the STEADI initiative (Stopping Elderly Accidents Deaths and Injuries) as a comprehensive strategy to reduce falls in older adults. STEADI incorporates empirically supported clinical guidelines and scientifically tested interventions to help primary care providers address patient fall risk through the identification of modifiable risk factors and implementation of effective interventions (e.g., medication management) ( 25).

A number of strategies have been suggested for preventing injuries in children in general, including those resulting from falls. These include the use of safety gates at the top and bottom of stairways; ensuring that children aged <6 years do not sleep in the top bunk of a bunk bed; seat belt use in a shopping cart; use of an appropriate helmet for activities such as bicycle riding, skateboarding, and horseback riding; and age- and activity-appropriate supervision by adult caregivers ( 26- 28). To prevent TBIs related to motor-vehicle crashes among infants and children, children should sit in the back seat until aged 13 years and be seated in age- and size-appropriate car seats ( 29). Unrestrained children aged 4-15 years are three times more likely to sustain a TBI than children who were restrained ( 30). The American Academy of Pediatrics (AAP) recommends that infants and toddlers remain in a rear-facing car safety seat until aged 2 years or until they reach the height and weight limit designated by the manufacturer of the car seat, then be restrained in forward-facing car seats (until they reach the height/weight limits on their car seats) ( 29). AAP recommends that children sit in a booster seat once they outgrow child safety seats and can fit appropriately into an adult seat belt ( 29).

The leading cause of TBI-related death among those aged 0-4 years was assault/homicide, including abusive head trauma by inflicted blunt impact or violent shaking, and other causes, such as firearm-related injuries ( 31). A number of strategies have been developed to prevent child abuse and neglect. To help communities make use of the best available evidence for prevention, CDC has released a technical package that describes a set of strategies and examples of specific approaches that enhance safe, stable, nurturing relationships and environments for children and families to reduce abuse and neglect and promote health ( 32).

The highest rates of TBI-EDHDs occurring after being struck by or against objects were among those aged 0-24 years. Sports- and recreation-related activities likely contribute to these types of injuries, especially for those aged 4-24 years. However, this analysis did not look at specific E-codes as a means to identify sports- and recreation-related TBIs. Although E-codes have been used to identify sports-related injuries ( 33), it is challenging to describe all activities associated with sports and recreation using these data due to differences in coding policies among health care providers, limited documentation in medical records, and limited utility of E-codes. To obtain greater detail about the nature of "struck by or against" related injuries and identify targets for prevention, use of other data sources would be needed. For example, the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) includes narratives with each record that provide a short description of the injury event. Sometimes this includes what the person was doing at the time of injury and additional parties involved. Such information has been more useful in identifying risk factors for strike-related TBI incidence ( 22).

The most common principal mechanism of TBI-EDHDs among persons aged 15-24 and 25-34 years was motor-vehicle crashes. This corresponds with the age groups that are known to be at higher risk for a motor-vehicle crash ( 34). Several factors have contributed to increased motor vehicle-related injuries in teens and young adult drivers compared to older drivers, including a reduced ability to recognize driving hazards and unsafe road conditions ( 35), low frequency of seat belt use ( 36), and higher levels of alcohol-impaired driving ( 37). The motor vehicle mechanism category used in the analysis includes injuries to pedal cyclists and pedestrians by motor vehicles. However, previous research has shown that approximately 70% of the motor-vehicle-related TBIs in persons aged 15-34 years involve occupants of a vehicle, approximately 12% involve motorcycle passengers, and approximately 8% involve pedestrians ( 1).

Compared to 2007, in 2013 the overall age-adjusted rate of TBI-related hospitalizations attributable to motor-vehicle crashes decreased, with the largest decreases occurring among those aged 15-24 years. This may be due to the implementation of programs and policies focused on young and inexperienced drivers. Programs such as graduated drivers licensing focus on young drivers as a way to increase safety awareness and reduce driving under high-risk driving conditions when the driver is still relatively inexperienced ( 38). All states have instituted zero tolerance for alcohol and driving among young drivers (i.e., those aged <20 years) ( 39). Overall decreases in these motor-vehicle-related hospitalizations were likely the result of both behavioral and vehicle improvements such as the increased use of seatbelts and vehicle safety measures such as airbags and electronic stability control ( 40- 42). These advances have helped to reduce the incidence of motor-vehicle crashes but might also contribute to decreased injury severity, resulting in fewer TBIs that require hospitalization.

Although the number of TBI-related deaths increased from 2007 to 2013, the age-adjusted rate of TBI-related deaths decreased. This decrease was largely attributable to a decrease in the rate of fatal TBIs in motor-vehicle crashes. However, to some extent, this decrease has masked increases during the same period in fatal TBIs caused by falls, particularly among older adults, and an increase in fatal TBIs attributable to intentional self-harm. Fatal TBIs attributable to intentional self-harm were found predominantly among males; firearms were the predominant principal mechanism of injury. The increase in fatal TBIs attributable to intentional self-harm is consistent with an overall increase in suicide rates in the United States and underscores the importance of comprehensive and coordinated prevention efforts, including efforts to enhance social support and connectedness, reduce stigma for help-seeking, and provide support for those at greatest risk ( 43,44).

The increase in the overall number of TBI-related hospitalizations and deaths attributable to older adult falls might be in some part attributable to increased life expectancy combined with the increased risk of falls among older adults ( 45). However, the increase in life expectancy during the relatively short period of time covered by this analysis (from 78.1 years in 2007 to 78.8 in 2013) cannot explain such a large increase in the rate of TBI-related hospitalizations and deaths attributable to falls among older adult age groups. The reason or reasons for this increase are unknown.

Limitations

The findings in this report are subject to at least three limitations. First, these findings might overestimate the incidence of TBI-related ED visits and hospitalizations because the data are collected at the visit-level only. Thereby multiple records might exist for a single injury as persons might present more than once for treatment. However, steps were taken to reduce the number of records that were double-counted, including removing in-hospital deaths (that would be included in the mortality data) and excluding hospital transfers but residual double counting for multiple encounters/readmissions cannot be ruled out. Second, clinical severity cannot be ascertained from hospital administrative data that are not primarily designed for public health surveillance. Although TBIs are included as a diagnosis in the HCUP NIS and NEDS records, the severity of these injuries is unknown, nor is it known if hospital admissions with multiple diagnoses were attributable to the head injury or to another diagnosis. Third, this study does not include data on persons who did not seek care for their TBI or those who sought care in an outpatient setting. As a result, the TBI-EDHDs described in this report are not a complete accounting of all TBIs occurring in the United States and likely an undercount of TBIs that are milder in severity.

Conclusion

In 2013, approximately 2.8 million TBI-related ED visits, hospitalizations, and deaths occurred in the United States, representing an increase since 2007 that was largely attributed to an increase in the number and rate of TBI-related ED visits. Although much public interest has been devoted to sports-related concussion in youth, the findings in this report indicate that older adult falls account for a much larger proportion of the increase in TBI-related ED visits during this period. In addition, although the modest increases in ED visits that might be attributed to youth sports concussion do not extend to increases in TBI-related hospitalizations and deaths, the same cannot be said for TBIs attributable to older adult falls. From 2007 to 2013, increases in TBI-related hospitalizations and deaths attributable to older adult falls suggest the need for greater attention to preventing older adult falls. Empirically validated prevention measures can help reduce the incidence of older adult falls.

The decrease in TBI-related deaths caused by motor-vehicle crashes from 2007 to 2013 is likely attributable to efforts to prevent motor-vehicle crashes. Nevertheless, more can be done to further reduce motor-vehicle crashes. The United States lags behind other high-income countries in the rate of motor-vehicle crash deaths; in 2013, the rate of motor-vehicle crash deaths in the United States was more than double the average rate of other high-income comparison countries ( 46). Redoubling efforts to increase restraint use and reduce alcohol-impaired driving, among other proven interventions, are critical to the continued reduction of motor-vehicle crashes and motor-vehicle crash-related TBIs.

Corresponding author: Matthew J. Breiding, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control. Telephone: 770-488-1396; E-mail: dvi8@cdc.gov.

¹Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control; ² Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control

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Suggested citation for this article: Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013. MMWR Surveill Summ 2017;66(No. SS-9):1-16. DOI: http://dx.doi.org/10.15585/mmwr.ss6609a1external icon .

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Traumatic Brain Injury-Related Emergency Department Visits ...

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Problem/Condition: Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007.

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Centers for Disease Control and Prevention

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Prevent TBIs and future unintentional injuries by understanding the risks.

Brain Injury Awareness Month is an important time to highlight the lifelong effects of a traumatic brain injury (TBI). A TBI is caused by a bump, blow, or jolt to the head, or a penetrating head injury that disrupts the normal function of the brain. People who have had a moderate to severe TBI may experience changes in thinking and balance, which may put them at greater risk of later unintentional injuries. TBIs also increase the risk of dying from several other causes. For example, compared to people without TBI, people with TBI are more likely to die from:

Seizures: 50 times more likely

Unintentional drug poisoning: 11 times more likely

Infections: 9 times more likely

Pneumonia: 6 times more likely

The leading causes of TBIs include falls among older adults, being struck by or against an object, assaults, and motor vehicle crashes. Current efforts to reduce unintentional injuries include preventing older adult falls, improving sports concussion culture, and increasing motor vehicle safety. This public health approach to injury prevention can reduce the rate of TBI and its long-term consequences.

Preventing Older Adult Falls

According to CDC data, almost 8 out of 10 TBIs among older adults are caused by a fall. Emergency department visits more than doubled from 2007-2013, reaching more than 394,000 visits. Hospitalizations increased by almost 50 percent, resulting in more than 91,000 stays. Falls are preventable. Here are some steps that older adults can take to prevent falls:

Talk to your doctor.

Do strength and balance exercises.

Have your eyes checked.

Make your home safer.

Learn more about older adult falls on the STEADI website.

Improving Sports Concussion Culture

CDC has a new educational gaming app designed to teach children 6-8 years old about basic concussion safety. Children can learn the benefits of playing it safe and smart through a futuristic world of galactic racing adventures. The app teaches children about the different ways the brain can get hurt during sports activities and how important it is to tell a coach, parent, or other adult when an injury occurs. Learn more about this free app here!

Based on our research, we know that prevention is possible. We've made youth sports concussion one of our focus areas, but we can't solve this issue alone. All of us play a role in creating a culture of concussion safety. Here's how:

Increasing Motor Vehicle Safety

For youth and young adults, motor vehicle crashes were the main cause of TBI-related deaths, and accounted for 56% of TBI-related deaths among 5 to 14 year-olds, and 47% of TBI-related deaths for 15 to 24 year-olds from 2006-2010. Everyone can improve motor vehicle safety by:

Using seat belts on every trip, no matter how short. Make sure passengers buckle up too.

Buckling children in age and size appropriate car seats, booster seats, and seat belts. Those ages 12 and under should be buckled in the back seat.

Choosing not to drive after drinking alcohol or using drugs and helping others do the same.

Knowing your state's graduated driver licensing laws, and consider using tools such as CDC's parent-teen driving agreement if you are the parent of a teen driver.

Learn more about all of these tips on the Motor Vehicle Safety website.

Learn More About Traumatic Brain Injury

Traumatic brain injuries are a serious public health problem in the United States. TBIs are a major cause of death and disability contributing to about 30% of all injury deaths. Every day, 138 Americans die from injuries that include TBI. Those who survive a TBI can face effects lasting a few days to disabilities which may last the rest of their lives. Effects of TBI can include impaired thinking or memory, movement, sensation (e.g., vision or hearing), or emotional functioning (e.g., personality changes, depression). These issues not only affect individuals, but can have lasting effects on families and communities. To learn more about TBIs, visit:

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Prevent TBIs and future unintentional injuries by understanding the risks. Brain Injury Awareness Month is an important time to highlight the lifelong effects of a traumatic brain injury (TBI). A TBI is caused by a bump, blow, or jolt to the head, or a penetrating head injury that disrupts the normal function of the brain.

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You Can Prevent Traumatic Brain Injury

1. Buckle Up Every Ride – Wear a seat belt every time you drive – or ride – in a motor vehicle.

2. Never drive while under the influence of alcohol or drugs.

3. Wear a helmet, or appropriate headgear, when you or your children:

4. Ride a bike, motorcycle, snowmobile, scooter, or use an all-terrain vehicle;

5. Play a contact sport, such as football, ice hockey, or boxing;

6. Use in-line skates or ride a skateboard;

7. Bat and run bases in baseball or softball;

8. Ride a horse; or ski or snowboard.

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CDC’s Effort to Build a National Concussion Surveillance System

The Traumatic Brain Injury Program Reauthorization Act of 2018 was signed into law on December 21, 2018. This bill directs CDC to implement a National Concussion Surveillance System.

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National Concussion Surveillance System | Concussion | Traumatic Brain Injury | CDC Injury Center

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CDC began pilot testing a survey about TBI experienced by children and adults in fall 2018. The pilot results will help refine plans for a National Concussion Surveillance System (NCSS). NCSS will help improve prevention, care, and recovery efforts underway at CDC and among groups invested in helping those who experience a TBI.

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5. The National Concussion Surveillance System

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5. The National Concussion Surveillance System

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The National Concussion Surveillance System will enable CDC to accurately determine how many Americans (children and adults) get a concussion each year and how the injury occurred. In addition, the results of a full-scale national system such as this would inform and equip leaders within communities, states, and across the country by:

1. Providing the first national estimates of the number of sports-related concussion among youth that occur both in and outside of organized sports;

2. Monitoring trends to understand whether the number of concussions is increasing or decreasing, and assessing the effectiveness of prevention efforts;

3. Giving insight to health care providers and hospitals about where patients are seeking care for concussion and recovery needs; and

4. Creating, for the first time ever, true national estimates of the number of people living with a disability caused by a brain injury.

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Abstract

1. Introduction

In recent years, youth sports concussion has become a prominent public health concern in the United States. Apprehension about the long-term effects of concussive and sub-concussive impacts has led to a wide range of responses including educational campaigns, increased research, rule changes among youth sports organizations, and the enactment of youth sports concussion laws in all 50 states. In 2013, the National Academy of Sciences (NAS), formerly the Institute of Medicine, examined this issue and produced a report, Sports-related Concussions in Youth: Improving the Science, Changing the Culture, describing the current state of scientific knowledge regarding youth sports concussion ( Institute of Medicine (IOM) and National Research Council (NRC), 2014). The report outlines several recommendations to address knowledge gaps ( Institute of Medicine (IOM) and National Research Council (NRC), 2014). Among them was a call for the Centers for Disease Control and Prevention (CDC) to design and implement a surveillance system that provides comprehensive incidence estimates of sports concussion among persons 5 to 21 years of age ( Institute of Medicine (IOM) and National Research Council (NRC), 2014). In addition, the report includes a recommendation to collect data on the "cause, nature, and extent of the concussive injury" (1: p. 286), such as information related to the sport or activity in which the concussion was sustained, level of competition (e.g., recreational or competitive level), event type (i.e., practice or competition), impact location, nature of the injury (i.e., type of contact), and the signs and symptoms experienced. A concussion is considered a type of traumatic brain injury, on the mild end of the severity spectrum, and has been described as a "clinical syndrome of biomechanically induced alteration of brain function, typically affecting memory and orientation, which may involve loss of consciousness" ( Giza, Kutcher, Ashwal, Barth, Getchius, & Gioia et al., 2013).

Since the release of the NAS report, CDC has considered the surveillance recommendation as a call to action, not only to provide incidence estimates for youth sports concussion but to improve TBI surveillance more broadly. In considering how to best address the NAS surveillance recommendation, it was clear that some of the gaps in current incidence estimates of youth sports concussion are similar to the gaps in current incidence estimates for TBI overall. In the interest of more efficiently utilizing resources, CDC quickly pivoted from the narrower request of better capturing incidence estimates of youth sports concussion to identifying how to better capture incidence estimates of TBI more broadly. This commentary discusses the current surveillance landscape and opportunities for improvement, including a strategy to obtain more comprehensive information about TBI and youth sports concussion.

2. The current surveillance landscape

To date, national TBI incidence estimates have been derived from administrative claims databases, such as those available through the Healthcare Cost and Utilization Project (HCUP). International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes are used to identify TBI-related visits. For example, data obtained from HCUP's Nationwide Emergency Department Sample and HCUP's National Inpatient Sample are used by CDC to describe TBI-related ED visits and hospitalizations, respectively. Mortality data are obtained from vital statistics records using ICD-10 codes associated with TBI. Unfortunately, reliance on this method to describe TBI in the United States has at least 4 limitations: (1) ICD-9-CM codes have limited sensitivity and specificity and can lead to an undercount of TBI cases ( Coronado et al., 2012; Leibson et al., 2011); (2) limited data elements in administrative databases do not permit comprehensive observation of factors associated with injury; (3) surveillance using this method excludes persons who receive outpatient care or persons who do not seek medical care; and (4) sports- and recreation-related (SRR) TBIs are difficult to abstract with ICD-9-CM-based external cause-of-injury codes (E-codes) ( Centers for Disease Control and Prevention, 2011), as there are few codes to represent the vast number of SRR activities and they are often underutilized for claims purposes. Further, sports concussions are not able to be identified because the codes were not designed to definitively determine whether a TBI was sports-related. Similar limitations apply to national estimates of TBI-related disability, as the most recent of these have been calculated using an extrapolation to the national level based on data from a single state (Selassie et al., 2008; Zaloshnja, Miller, Langlois, & Selassie, 2008). These limitations likely contribute to a significant underestimate of the number of TBIs that occur each year and the number of people living with a TBI-related disability.

National surveillance for sports concussion cannot be conducted using the aforementioned administrative databases. However, several ongoing data collection methods have been used to examine the incidence of SRR injuries. Currently, there are three large-scale surveillance systems that have been used to identify SRR injuries-High School Reporting Information Online (HS-RIO), the National Collegiate Athletic Association-Injury Surveillance Program (NCAA-ISP), and the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). HS-RIO and NCAA-ISP are web-based systems that allow athletic trainers to submit comprehensive information regarding an injured student athlete; examples of the type of information collected include the injury type, position played, and time elapsed before return-to-play. NEISS-AIP contains data on initial visits for injuries treated in a nationally representative sample of emergency departments (EDs) (Schroeder & Ault, 2001; HS-RIO and NCAA-ISP). Unlike HS-RIO and NCAA-ISP, NEISS-AIP includes data for persons of all ages and captures concussions sustained while engaged in a broader range of activities, including non-school-based organized sports and recreational activities (e.g., bicycling, playground activities, and "pick-up" games).

Although HS-RIO, NCAA-ISP, and NEISS-AIP have provided useful information about youth sports concussion, there are gaps in their ability to produce a comprehensive incidence estimate of SRR concussions. First, current trainer-based systems (HS-RIO and NCAA-ISP) are unable to capture SRR concussions sustained below the high school level and are unable to capture concussions sustained outside of organized, school-based sports (e.g., recreational leagues, "pick-up games"). Second, while many high school students participate in school-based athletic programs, this is not the case at the college level. Consequently, only a small fraction of sports-related concussions among college-aged students are captured by NCAA-ISP. Third, NEISS-AIP is limited to capturing SRR concussions that are the primary diagnosis in an ED setting. It has similar problems to the administrative healthcare datasets described earlier in that it does not capture SRR concussions for which people do not seek care or concussions initially treated in non-hospital settings.

3. Proposed method to address surveillance gaps

After a review of existing data sources, CDC concluded that a household survey has the most potential to sufficiently address key gaps in current TBI surveillance efforts. Specifically, CDC believes that a household survey is an efficient means to comprehensively capture TBIs that are not treated or are treated in non-hospital settings such as primary care, urgent care, and specialty care. Further, specific to SRR concussions, this method can comprehensively capture SRR concussions below the high school level and concussions that occur outside of organized, school-based settings. Finally, this methodology can be used to obtain needed information from respondents such as the circumstances of the TBI, recurrent TBI, the impact of the TBI, and care received post-TBI.

3.1. Household survey for traumatic brain injury

In collaboration with academic and federal partners with expertise in public health surveillance and TBI, CDC developed a survey that will be piloted as a random-digit-dial, household telephone survey. Survey interviewers will ask adult respondents whether they sustained a head injury within the past 12 months. If a head injury is reported, the respondent will be asked questions about signs and symptoms experienced due to the head injury. If one or more head injuries meet the case definition for TBI (including concussion), based on the signs and symptoms reported, the adult will be asked follow-up questions about the most recent TBI. Follow-up questions will elicit additional information such as the circumstances of injury and medical care received, including the setting where medical care was sought and the time elapsed between injury and medical evaluation. If a TBI is determined to be SRR, activity-specific information will be collected such as personal protective equipment used. In addition, adults will be asked if they are currently experiencing TBI-related disability. The disability questions are consistent with the questions used in the most recent Behavioral Risk Factor Surveillance System (BRFSS) survey ( Courtney-Long et al., 2015) and assess the presence of physical or cognitive disabilities related to a head injury.

3.2. Flexibility of the proposed methodology

This particular methodology also has the flexibility to capture TBI and concussions among children and adolescents. The survey interviewer will ask adult respondents with children to serve as proxy reporters for those 5 to 17 years of age that reside in their home. Similar to adult respondents, they will be asked whether each child has had a head injury within the past 12 months. If a head injury is reported, the proxy reporter will be asked follow-up questions that mirror those asked of adults. Further, SRR-specific questions will also be asked when applicable, including questions about the process of returning to play and school. This methodology has the potential to address existing surveillance gaps and address the NAS recommendations.

It is also important to note that by utilizing a household survey for ongoing surveillance, CDC will have the flexibility to modify the survey from year to year. While the core questions that assess incidence should remain the same over time for comparability from year to year, the ability to add new questions provides an opportunity to monitor emerging concerns, or even specific research questions that can inform public health action.

3.3. Challenges of the proposed methodology

A household survey administered as a random-digit-dial, telephone survey is not without limitations. Response rates for telephone surveys have been decreasing over time ( Groves, 2006) and the increased use of cell phones necessitates a complex dual-frame design that accounts for both landlines and cell phones ( Center for Disease Control and Prevention, 2015; Greby et al., 2012).

Recall bias is a potential issue as it is optimal for information to be elicited about symptom presentation as soon as possible after a TBI ( Rowhani-Rahbar, Chrisman, Drescher, Schiff, & Rivara, 2015). It may also be difficult for respondents to remember specific details about injuries sustained over the course of a 12-month period or it may be challenging to recall how long ago events occurred ( Gaskell, 2000). Another limitation for this type of injury is the lack of a validated, consensus case definition for TBI surveillance ( Carman et al., 2015), creating the potential for false negatives and false positives. However, to be fair, this is a challenge for any surveillance effort, particularly those attempting to assess TBIs at the milder end of the severity spectrum.

Using adults as proxy reporters may result in inaccurate reporting of symptoms on behalf of children and adolescents. Researchers recommend that both the proxy reporter and the child be asked to report ( Cantor et al., 2004; Sady, Vaughan, & Gioia, 2014). A recent study assessing agreement between young athletes and parents found there was substantial variability in the specific symptoms reported ( Rowhani-Rahbar et al., 2015). This could lead to differential conclusions for the same TBI. There are also concerns that older children may not disclose symptoms and parents may have difficulty recognizing signs and symptoms in younger children.

To address a number of these concerns, the pilot study of CDC's household survey will: (1) not assess TBIs in children younger than 5 years of age; (2) directly interview adolescents 12 to 17 years of age to compare their responses with the information provided by their parent or guardian; (3) determine whether a 6-month reporting period results in enough TBI cases to produce stable incidence estimates. The comparison between parent or guardian and child reporting will suggest whether direct adolescent reporting should replace proxy reporting, complement proxy reporting, or be removed altogether, in the ongoing surveillance system. Despite these potential concerns about proxy reporting, it is also important to remember that TBIs captured by current surveillance systems almost entirely miss TBIs unknown to parents and guardians.

4. Conclusion

Significant public health action has been undertaken to reduce the impact of TBI and youth sports concussion. However, these actions have been undertaken in the absence of comprehensive national incidence estimates that would permit a better understanding of the true scope of the problem. As a result, we do not know whether strategies aimed at preventing TBI have been effective. This also applies to youth sports concussion where public concern continues to grow and the potential health consequences are troubling. CDC has proposed a methodology to address the gaps in TBI surveillance, and is poised to pilot a national household survey aimed at providing the first comprehensive incidence estimates of TBI and youth sports concussion. Additionally, the survey will provide an estimate of TBI-related disability among adults as well as a comprehensive picture of healthcare utilization following TBI. The results of the pilot will be used to modify the methodology for the implementation of the surveillance system, contingent upon the allocation of resources. Moreover, the estimates derived from this proposed method will answer key questions that will inform public health action and the actions of the public.

Acknowledgments

The Journal of Safety Research has partnered with the Office of the Associate Director for Science, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control at the CDC in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the 46th in a series of "From the CDC" articles on injury prevention.

Footnotes

Disclaimer: The findings and conclusion of this research are those of the authors and do not represent the official views of the US Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC). The inclusion of individuals, programs, or organizations in this article does not constitute endorsement by the US federal government, DHHS, or CDC.

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CDC's efforts to improve traumatic brain injury surveillance

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Youth sports concussion has become a prominent public health issue due to growing concern about the risk of long-term health effects.A broad spectrum of stakeholders has convened to propose solutions, including a committee of the National Academy of Sciences ...

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6. Communication Technology to Improve Health outcomes

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6. Communication Technology to Improve Health outcomes

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Children have the highest rate of emergency department visits for traumatic brain (TBI) injury of all age groups. TBI affects children differently than adults. An injury of any severity to the developing brain can disrupt a child’s development, and may result in restrictions in school and participation in activities (e.g., sports).  As a result of TBI, children can experience changes in their health, thinking, and behavior that affect learning, self-regulation, and social participation, all of which are important in becoming a productive adult.

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7. TBI-related Emergency Department Visits, Hospitalizations, and Deaths

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7. TBI-related Emergency Department Visits, Hospitalizations, and Deaths

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In 2014, there were approximately 2.87 million TBI-EDHDs in the United States, including over 837,000 occurring among children. This includes:

Approximately 2.53 million TBI-related ED visits, including over 812,00 occurring among children.

Approximately 288,000 TBI-related hospitalizations, including over 23,000 occurring among children.

56,800 TBI-related deaths, including 2,529 occurring among children.

# data[].attributes.body
Bell, J., Breiding, M., & DePadilla, L. (2017). Cdc's efforts to improve traumatic brain injury surveillance. Journal of Safety Research, 62, 253-256. doi:10.1016/j.jsr.2017.04.002

Center for Disease Control and Prevention (2019). Traumatic Brain Injury and Concussion. Retrieved from https://www.cdc.gov/traumaticbraininjury/index.html