Traumatic Brain Injuries in Massachusetts

1
Traumatic Brain Injuries in Massachusetts

• Injury Surveillance Program
• Center for Health Statistics, Information,
  Research and Evaluation
• Massachusetts Department of Public Health
• August 2004

2
What is a Traumatic Brain Injury (TBI)?

• An injury to the head resulting from blunt,
  penetrating, and/or acceleration/deceleration
  forces, and resulting in any of the following
• Decreased level of consciousness
• Amnesia (memory loss)
• Skull fracture
• Intracranial lesions (bleeding)
• Other neurologic or neuropsychologic
  abnormalities
• Concussions are a type of TBI

Source State and Territorial Injury Prevention
Directors Association (STIPDA), 1999
3
Importance of Traumatic Brain Injury

• Nationally, an estimated 1.5 million people
  sustain a TBI each year.
• Approximately 50,000 of these are fatal.
• At least 5.3 million Americans (2) of population
  currently live with disabilities resulting from
  TBI.

Source Centers for Disease Control and
Prevention, Traumatic Brain Injury Fact Sheet
4
Consequences and Costs of Traumatic Brain Injury

• TBI may lead to problems with cognition,
  concentration, mood, movement, balance, sensation
  and vision, emotional instability, and seizure
  disorders.
• In the U.S. in 1995, the direct and indirect
  costs of TBI totaled and estimated 56.3 billion.
• In MA, in FY2003, the acute care hospital charges
  for TBI-related hospitalizations alone were over
  151 million. Nearly half of these charges were
  to a public payer source.

Sources Centers for Disease Control and
Prevention, Traumatic Brain Injury Fact Sheet MA
Hospital Discharge Database, MA Division of
Health Care Finance and Policy Includes
Medicare, Medicaid, and free care.
5
Massachusetts Data Sources

• Death Data
• Registry of Vital Records and Statistics,
• MA Department of Public Health
• Acute Care Hospital Discharge Data
• MA Hospital Discharge Database
• MA Division of Health Care Finance and Policy
• Emergency Department (ED) Data
• MA Emergency Department Database
• MA Division of Health Care Finance and Policy
• - The 2002 ED data presented here includes
  deaths occurring at an Emergency Department. It
  does not include those individuals hospitalized
  through the ED.

6
Magnitude of Traumatic Brain Injury in
Massachusetts
7
Traumatic Brain Injury Fatalities MA Residents,
1995-2002 (N4,395)

• The MA crude TBI-related death rate in 2002 was
  8.3 per 100,000 residents.
• Traumatic brain injuries occurred in 20 of
  all injury deaths in 2002.

Source Registry of Vital Records and Statistics,
MA Department of Public Health Prepared by The
Injury Surveillance Program, MA Department of
Public Health
8
Acute Care Hospitalizations for Nonfatal TBI MA
Residents, FY 1995-2003

• The MA crude hospital discharge rate for
  non-fatal TBI was 73 per 100,000 in 2003.
• Between 1995 and 2003 there was a 24
  increase in acute care hospitalizations
  for TBI. Most of the increase was due to
  increases in fall- related traumatic brain
  injuries.

Source MA Hospital Discharge Database, MA
Division of Health Care Finance and Policy.
Prepared by The Injury Surveillance Program, MA
Department of Public Health
9
Massachusetts Emergency Department Visits for
Traumatic Brain Injuries, FY 2002

• 33,073 ED visits for TBI
• The crude ED visit rate for TBI is 520.9 per
  100,000

Source MA Emergency Department Discharge
Database, MA Division of Health Care Finance and
Policy Prepared by The Injury Surveillance
Program, MA Department of Public Health Includes
all discharge dispositions, including death in ED
10
Leading Causes of Traumatic Brain Injury in
Massachusetts
11
Causes of Fatal Traumatic Brain Injury MA
Residents, 2002 (N530)
-- 67 were unintentional 18 were suicide 11
were homicide
Source Registry of Vital Records and Statistics,
MA Department of Public Health Prepared by The
Injury Surveillance Program, MA Department of
Public Health
12
Leading Causes of TBI Fatalities MA Residents,
1995-2002

• Between 1995 and 2002
• 77 increase in fall-related TBI deaths 46
  increase in MV occupant -related TBI deaths 24
  decrease in firearm-related TBI deaths

Source Registry of Vital Records and Statistics,
MA Department of Public Health Prepared by The
Injury Surveillance Program, MA Department of
Public Health
13
Average Annual Number of TBI Deaths By Selected
Causes and Age Groups, MA Residents, 2000-2002
Source Registry of Vital Records and Statistics,
MA Department of Public Health Prepared by The
Injury Surveillance Program, MA Department of
Public Health
14
Causes of Nonfatal TBI HospitalizationsMA
Residents, FY 2002 (N4,258)

Source MA Hospital Discharge Database, MA
Division of Health Care Finance and Policy.
Prepared by The Injury Surveillance Program, MA
Department of Public Health Other includes
unknown, unspecified, or other specified causes
15
Number of Nonfatal TBI Hospitalizations By
Selected Causes and Age Groups, MA Residents, FY
2002
Source MA Hospital Discharge Database, MA
Division of Health Care Finance and Policy.
Prepared by The Injury Surveillance Program, MA
Department of Public Health
16
Causes of Emergency Department Visits for TBIMA
Residents, FY2002 (N33,073)

Source MA Emergency Department Discharge
Database, MA Division of Health Care Finance and
Policy Prepared by The Injury Surveillance
Program, MA Department of Public Health 1 Other
includes unknown, unspecified, or other specified
causes. Includes all discharge dispositions,
including deaths in ED
17
Annual Number of ED Visits for TBI By Selected
Causes and Age Groups, MA Residents, FY 2002
Source MA Emergency Department Discharge
Database, MA Division of Health Care Finance and
Policy Prepared by The Injury Surveillance
Program, MA Department of Public Health Includes
all discharge dispositions, including deaths in ED
18
Risk Factors for Traumatic Brain Injury in
Massachusetts
19
Average Annual TBI Death Rates By Sex and Age
Group, MA Residents, 2001-2002 (N1,133)
Source Registry of Vital Records and Statistics,
MA Department of Public Health Prepared by The
Injury Surveillance Program, MA Department of
Public Health
20
Hospitalization Rates for Nonfatal TBI By Sex and
Age Group, MA Residents, FY 2002 (N4,258)
Source MA Hospital Discharge Database, MA
Division of Health Care Finance and Policy.
Prepared by The Injury Surveillance Program, MA
Department of Public Health
21
Emergency Department Visit Rates for TBIBy Sex
and Age Group, MA Residents, FY 2002 (N33,073)
Source MA Emergency Department Discharge
Database, MA Division of Health Care Finance and
Policy Prepared by The Injury Surveillance
Program, MA Department of Public Health Includes
all discharge dispositions, including death in ED
22
Traumatic Brain Injury Death Rates By Race and
Ethnicity, MA Residents, 2002 (N528)
N35
N443
N33
N17
Source Registry of Vital Records and Statistics,
MA Department of Public Health Prepared by The
Injury Surveillance Program, MA Department of
Public Health All other race/ethnicity 2, not
depicted in the graphic. Rates based on numbers
less than 20 may be unstable.
23
Acute Care Hospitalization Rates for Nonfatal
TBIBy Race and Ethnicity1, MA Residents, FY 2002
(N4,032)
N241
N 3,452
N274
N33
N17
N65
Source MA Hospital Discharge Database, MA
Division of Health Care Finance and
Policy Prepared by The Injury Surveillance
Program, MA Department of Public Health 1 Other
race/ethnicity 226, and not depicted in the
graphic.
24
Traumatic Brain InjuriesMassachusetts Residents,
2002
1 Death
For every
8 Hospital Discharges
62 Emergency Department Visits
Sources Registry of Vital Records and
Statistics, MA Department of Public Health MA
Hospital Discharge Database and MA Emergency
Department Database, MA Division of Health Care
Finance and Policy Prepared by The Injury
Surveillance Program, MA Department of Public
Health
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Traumatic Brain Injury Prevention Tips

• Always wear a seat belt when you drive or ride in
  a motor vehicle. Never drive under the influence
  of alcohol or drugs. Always buckle your child
  into a child safety seat, child booster seat or
  seat belt (according to the childs weight,
  height and age) in the car.
• Always wear a helmet
• when riding a motorcycle, bicycle, scooter or
  ATV playing a contact sport batting and running
  bases skiing or snowboarding inline skating or
  riding a skateboard riding a horse.
• Avoid falls by
• Installing handrails removing tripping hazards
  maintaining a regular exercise program to improve
  strength, balance, and coordination seeing an
  eye doctor regularly installing window guards
  using nonslip mats and installing grab bars in
  tubs and showers.
• Keep firearms stored unloaded in a locked cabinet
  or safe. Store bullets in a separate location.
• Make sure the surface of playgrounds are made of
  shock absorbing materials.
• Source The Centers for Disease Control and the
  Brain Injury Association of America.
  http//www.cdc.gov/node.do/id/0900f3ec8000dbdc/asp
  ectId/A0400033, accessed 8/21/04.

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Conclusions

• Traumatic brain injuries are an important public
  health concern in Massachusetts
• Falls are the leading cause of TBI death,
  hospitalization and ED visits in Massachusetts
• Individuals 85 and over have the highest rates of
  TBI death and hospitalization. Infants under 1
  year have the highest rates of ED visits for TBI.
• TBIs ARE PREVENTABLE!

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Selected Resources for Traumatic Brain Injuries
in MA

• MA Department of Public Health
• Injury Prevention and Control Program
  617-624-5070
• Injury Surveillance Program 617-988-3318
• Office of Elder Health 617-624-5070
• MA Rehabilitation Commission
• Statewide Head Injury Program 617-204-3600
• MA Brain Injury Association 508-795-0244
• Brain Injury Information Hotline [phone]