Part I - Brain Injury

Federal Government

CDC Epidemiology Report

 

 

CDC Epidemiology Report

Of all common types of injury, those to the brain are among the most likely to result in death or permanent disability. Estimates of traumatic brain injury (TBI) incidence, severity, and cost indicate that these injuries cause enormous losses to individuals, their families, and society. They demonstrate a critical need for more effective ways to prevent these injuries and care for those injured.

There are several published epidemiologic studies of TBI-related hospitalizations and deaths in the U.S.:

Kraus has reviewed these studies in detail¹⁰. Most of them were conducted more than 15 years ago. The occurrence and causes of TBI today may differ. Because of the need for more current information on these injuries, the National Center for Injury Prevention and Control (NCIPC) and the Disability Prevention Program of the National Center for Environmental Health (NCEH) provide funding and technical support to several state health departments to develop TBI surveillance programs. The findings from current surveillance in some of these states will be published in the near future. Preliminary data suggest a recent decline in rates of hospitalization for TBI.

The NCIPC has published two recent TBI mortality studies:

There has been a 21 percent decline in the TBI-related death rate from 1979 to 1992.¹³ During this period, motor vehicle-related TBI death rates decreased 42 percent, fall-related TBI death rates decreased 14%, but firearm-related TBI death rates increased 10 percent.¹³

A number of studies have shown that males are about twice as likely to incur TBI as females. Most studies indicate that the highest rates of these injuries are found in persons 15-24 years of age. Persons under the age of 5 or over the age of 70 are also at high risk.

Each year more than 50,000 Americans die following traumatic brain injuries. The number of persons who have lifelong disability as a result of TBI is unknown but appears even larger. The federal Interagency Head Injury Task Force has estimated this number to be between 70,000-90,000 per year¹⁴. There are many kinds of impairments that may occur as a result of TBI. These injuries may impair cognition (e.g., concentration, memory, judgment, and mood), movement abilities (strength and coordination), and sensation (tactile sensation and special senses such as vision). TBI sometimes results in seizure disorders (epilepsy). About 1 percent of persons with severe TBI survive in a state of persisting unconsciousness.

There is no way to describe fully the human costs of traumatic brain injury: the burdens borne by those who are injured and their families. Only a few analyses of the monetary costs of these injuries are available, including the following estimate (in 1985 dollars):¹⁵

Direct annual expenditures $ 4.5 billion

Indirect annual costs $33.3 billion

Total $37.8 billion

A large number of people experience traumatic brain injury each year, often with severe consequences. This is a public health problem that requires:

The development of surveillance to obtain current information about the incidence, risk factors, causes, and outcomes of these injuries. CDC supports state TBI surveillance programs and provides guidelines for their design.¹⁶

The development based on accurate surveillance data of more effective strategies to prevent the occurrence of these injuries. In collaboration with other federal and state agencies, CDC supports programs for the primary prevention of motor vehicle-related injuries, other unintentional injuries, and violence-related injuries.¹⁷

The development of more effective strategies to improve the outcomes of these injuries and minimize disability among those injured. These secondary prevention efforts are supported within CDC by the Division of Acute Care, Rehabilitation Research and Disability Prevention (NCIPC), and the Disabilities Prevention Program (NCEH).¹⁸

References

1. Annegers JF, Grabow HD, Kurland LT, et al. The incidence, cause and secular trends in head injury in Olmstead County, Minnesota, 1935-1974. Neurology 1980;30:912-919.

2. Kalsbeek WD, McLaurin RL, Harris BS, Miller JD. The national head and spinal cord injury survey: Major findings. Journal of Neurosurgery 1980;53:S19-S24.

3. Klauber MR, Barrett-Connor E, Marshall LF, Bowers SA. The epidemiology of head injury: A prospective study of an entire community--San Diego County, California, 1978. American Journal of Epidemiology 1981;113:500-509.

4. Jagger J, Levine JI, Jane JA, Rimel RW. Epidemiologic features of head injury in a predominantly rural population. Journal of Trauma 1984;24:40-44.

5. Fife D, Faich G, Hollinshead W, Wentworth B. Incidence and outcome of hospital-treated head injury in Rhode Island. American Journal of Public Health 1986;76:773-778.

6. Whitman S, Coonley-Hoganson R, Desai BT. Comparative head trauma experience in two socioeconomically different Chicago-area communities: A population study. American Journal of Epidemiology 1984; 4:560-580.

7. Cooper KD, Tabaddor K, Hauser WA, et al. The epidemiology of head injury in the Bronx. Neuroepidemiology 1983;2:70-88.

8. Kraus JF, Black MA, Hessol N, et al. The incidence of acute brain injury and serious impairment in a defined population. American Journal of Epidemiology 1984;119:186-201.

9. MacKenzie EJ, Edelstein SL, FLynn JP. Hospitalized head-injured patients in Maryland: Incidence and severity of injuries. Maryland Medical Journal 1989:38:725-732.

10. Kraus JF. Epidemiology of head injury. In: Cooper, PR, ed. Head Injury, Third Edition. Baltimore: Williams and Wilkins, 1993; 1-25.

11. Sosin DM, Sacks JJ, Smith SM. Head injury associated deaths in the United States from 1979-1986. JAMA 1989;262:2251-5.

12. Sosin DM, Nelson DE, Sacks JJ. Head injury deaths: the enormity of firearms. JAMA 1992;268:791.

13. Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with brain injury. JAMA 1995;278:1778-80.

14. U.S. Department of Health and Human Services. Interagency Head Injury Task Force Report. Washington, DC: Department of Health and Human Services, 1989.

15. Max W, MacKenzie EJ, Rice DP. Head injuries: costs and consequences. Journal of Head Trauma Rehabilitation 1991;6(2):76-91.

16. Thurman DJ, Sniezek JE, Johnson D, Greenspan A, Smith SM. Guidelines for Surveillance of Central Nervous System Injury. Atlanta: Centers for Disease Control and Prevention, 1995.

17. National Committee for Injury Prevention and Control. Injury Prevention: Meeting the Challenge. New York: Oxford University Press, 1989.

18. Pope AM, Tarlov AR, editors. Disability in America: toward a national agenda for prevention. Washington, DC: National Academy Press, 1991.

 

in the United States¹

D.M. Sosin, J.E. Sniezek and D. J. Thurman

The 1991 National Health Interview Survey was analyzed to describe the incidence of mild and moderate brain injury in the United States. Data were collected from 46,761 households and weighted to reflect all non-institutionalized civilians. The report of one or more occurrences of head injury resulting in loss of consciousness in the previous 12 months was the main outcome measure. Each year an estimated 1.5 million non-institutionalized US civilians sustain a non-fatal brain injury that does not result in institutionalization, a rate of 618 per 100,000 person-years. Motor vehicles were involved in 28% of the brain injuries, sports and physical activity were responsible for 20%, and assaults were responsible for 9%. Medical care was sought by 75% of those with brain injury; 14% were treated in clinics or offices, 35% were treated in emergency departments, and 25% were hospitalized. The risk of medically attended brain injury was highest among three subgroups: teens and young adults, males, and persons with low income who lived alone. The incidence of mild and moderate brain injury in the United States is substantial. The National Health Interview Survey is an important national source of current outpatients brain-injury data.

1979 Through 1992: Success and Failure²

D.M. Sosin, J.E. Sniezek and R.J. Waxweiler

An average of 52,000 U.S. residents die each year with traumatic brain injuries. The brain-injury-associated death rate declined 22% from 24.6 per 100,000 U.S. residents in 1979 to 19.3 per 100,000 residents in 1992. Firearm-related rates increased 13% from 1984 through 1992, undermining a 25% decline in motor vehicle-related rates for the same period. Firearms surpassed motor vehicles as the largest single cause of death associated with traumatic brain injury in the United States. These data highlight the success of efforts to prevent traumatic brain injury due to motor vehicles and failure to prevent such injuries due to firearms. The increasing importance of penetrating injury has important implications for research, treatment, and prevention of traumatic brain injury in the United States.