Traumatic Brain Injuries in Massachusetts

Traumatic Brain Injuries in Massachusetts

Injury Surveillance ProgramCenter for Health Statistics, Information, Research and Evaluation

Massachusetts Department of Public Health

August 2004

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

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

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.

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.

Magnitude of Traumatic Brain Injury

in Massachusetts

Traumatic Brain Injury FatalitiesMA Residents, 1995-2002 (N=4,395)

603

530551562561

536525527

0

150

300

450

600

750

1995 1996 1997 1998 1999 2000 2001 2002

Year

TB

I F

ata

liti

es

• 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

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.

3,728

4,605

0

1,000

2,000

3,000

4,000

5,000

1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

TB

I Ho

spit

aliz

atio

ns

Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy.


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 PolicyPrepared by: The Injury Surveillance Program, MA Department of Public HealthIncludes all discharge dispositions, including death in ED

Leading Causes of Traumatic Brain Injury in

Massachusetts

Causes of Fatal Traumatic Brain Injury MA Residents, 2002 (N=530)

Other or Unspec.

20% (N=108)

Struck By4% (N=21)

MVOccupant

21% (N=113)

Firearm23%

(N=120)

Fall32%

(N=168)

-- 67% were unintentional; 18% were suicide; 11% were homicide

Source: Registry of Vital Records and Statistics, MA Department of Public HealthPrepared by: The Injury Surveillance Program, MA Department of Public Health

Leading Causes of TBI Fatalities MA Residents, 1995-2002

120158

168

95113

77

0

50

100

150

200

Year

TB

I F

ata

litie

sFirearm Fall MV-Occup.

• 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


Average Annual Number of TBI Deaths By Selected Causes and Age Groups, MA Residents, 2000-2002


0

10

20

30

40

50

60

Age Group (Years)

Nu

mb

er

of D

ea

ths

Falls

Motor Vehicle Occupant

Firearms

Causes of Nonfatal TBI HospitalizationsMA Residents, FY 2002 (N=4,258)

Falls50%

Pedal Cyclist3%

Other10%

Pedestrian5%

Struck By/Against

7%

MV Occupant25%

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

Number of Nonfatal TBI Hospitalizations By Selected Causes and Age Groups, MA Residents, FY 2002

0

100

200

300

400

500

600

<1 1 to 14

15 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 to 84

85 and overAge Group (Years)

Nu

mb

er o

f H

osp

ital

izat

ion

s

FallsMotor Vehicle OccupantStruck by


Causes of Emergency Department Visits for TBIMA Residents, FY2002 (N=33,073)

Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and PolicyPrepared 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

Fall39%

Other16%

MV-

Occupant18%

Struck by27%

Annual Number of ED Visits for TBI By Selected Causes and Age Groups, MA Residents, FY 2002

0

2,000

4,000

6,000

Age Group (Years)

Num

ber

of

ED

Vis

its

MV-Occupant

Struck by

Fall

Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and PolicyPrepared by: The Injury Surveillance Program, MA Department of Public Health

Includes all discharge dispositions, including deaths in ED

Risk Factors for Traumatic Brain Injury in Massachusetts

Average Annual TBI Death Rates By Sex and Age Group, MA Residents, 2001-2002 (N=1,133)

0.0

30.0

60.0

90.0

120.0

150.0

0 to 14

15 to 24

25 to 44

45 to 64

65 to 84

85 and overAge Group (Years)

Ra

te p

er

10

0,0

00

Males Females


Hospitalization Rates for Nonfatal TBI By Sex and Age Group, MA Residents, FY 2002 (N=4,258)


0.0

100.0

200.0

300.0

400.0

500.0

600.0

<1 1 to 1415 to 24

25 to 44

45 to 64

65 to 84

85+

Age Group (Years)

Ra

te p

er

10

0,0

00 Males Females

Emergency Department Visit Rates for TBIBy Sex and Age Group, MA Residents, FY 2002 (N=33,073)

0.0

400.0

800.0

1,200.0

1,600.0

2,000.0

<1 1 to 14

15 to 24

25 to 44

45 to 64

65 to 84

85 and over

Age Group (Years)

Ra

te p

er

10

0,0

00 Males

Females

Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and Policy


Includes all discharge dispositions, including death in ED

Traumatic Brain Injury Death Rates By Race and Ethnicity, MA Residents, 2002 (N=528)

0.0

2.0

4.0

6.0

8.0

10.0

12.0

White, NH Black, NH Asian, NH Hispanic

Race/Ethnicity

Rate

pe

r 1

00,0

00 N=443

N=35

N=17N=33


All other race/ethnicity = 2, not depicted in the graphic. Rates based on numbers less than 20 may be unstable.

Acute Care Hospitalization Rates for Nonfatal TBIBy Race and Ethnicity1, MA Residents, FY 2002 (N=4,032)

N=17N=33

Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy


1 “Other race/ethnicity” = 226, and not depicted in the graphic.

0.0

20.0

40.0

60.0

80.0

White Black Asian Hispanic

Race/Ethnicity

Rat

e p

er 1

00,0

00

N= 3,452N=241

N=65

N=274

Traumatic Brain InjuriesMassachusetts Residents, 2002

1 Death

~62 Emergency Department Visits

8 Hospital Discharges

For every:

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 PolicyPrepared by: The Injury Surveillance Program, MA Department of Public Health

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 child’s 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/aspectId/A0400033, accessed 8/21/04.

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.

• TBI’s ARE PREVENTABLE!

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: 800-242-0300

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Traumatic Brain Injuries in Massachusetts

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