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Traumatic Brain Injury in
the United States: Introduction Public Health Significance of Traumatic Brain Injury Traumatic brain injury is a leading cause of death and lifelong disability among children and young adults in the United States. The Centers for Disease Control and Prevention (CDC) has estimated that each year, approximately 1.5 million Americans survive a traumatic brain injury,1 among whom approximately 230,000 are hospitalized.2 Approximately 50,000 Americans die each year following traumatic brain injury, representing one third of all injury-related deaths.3 Adolescents, young adults, and the elderly are at highest risk of these injuries; the most common causes are attributed to motor vehicle crashes, falls, and violence.4 One study estimated that the annual economic burden of TBI in the United States was approximately $37.8 billion in 1985.5 This estimate included $4.5 billion in direct expenditures for hospital care, extended care, and other medical care and services; $20.6 billion in injury-related work loss and disability; and $12.7 billion in lost income from premature death. This study could not account for the intangible costs borne by the families and friends of individuals who die prematurely from brain injury. For injured persons and their loved ones, the physical and emotional tolls from permanent disability are profound and impossible to quantify. Thus, traumatic brain injuries have a deep impact on the population and require a response from the public health community to prevent these injuries and reduce consequent disabilities. To achieve this goal, the Division of Acute Care, Rehabilitation Research, and Disability Prevention in CDC's National Center for Injury Prevention and Control (NCIPC) has been working since 1989 to develop a traumatic brain injury surveillance system that provides representative data regarding the incidence, risk factors, and causes of traumatic brain injury in the United States and allows comparisons across jurisdictions. The system supports the development, implementation, and evaluation of programs for preventing traumatic brain injury. This effort is enabled, in part, by funding under Public Law 104-166, the Traumatic Brain Injury Act of 1996. What the Traumatic Brain Injury Act of 1996 Mandates Public Law 104-166 charges CDC with implementing projects to reduce the incidence of traumatic brain injury. Specifically, the legislation mandates that CDC shall:
Funding for all these activities was authorized at $3 million for each of the fiscal years 1997, 1998, and 1999.
CDC's Traumatic Brain Injury Surveillance Program, 1989-1998 Ongoing, population-based surveillance systems--and registries to define disability and other outcomes associated with TBI--are essential for planning and evaluating prevention, acute care, and rehabilitation services for people with these injuries. Yet such systems have only recently been established. Before 1990, most TBI data came from either hospital-based clinical case series or epidemiologic studies that were of limited duration and restricted to particular locales. Despite the limitations of these data sources, they revealed some useful insights into the epidemiology of TBI. During the 1970s and early 1980s, researchers estimated that each year, about 500,000 Americans sustained a brain injury leading to hospitalization or death.6 The reported annual incidence of TBI in different localities ranged from 132 to 367 injuries per 100,000 population,7-15 with the best estimate of national incidence at about 200 per 100,000 population.16 Different case definitions for TBI and varied methods of collecting data made it difficult to compare information from these studies, combine data across studies, and thus estimate the national incidence of TBI.17 In the case definition, for example, not all studies included skull fractures without other neurologic symptoms, and some excluded immediate deaths that did not involve hospitalization. Most studies focused on limited geographic areas that were not necessarily representative of the United States as a whole. From these studies it was not possible to evaluate U.S. trends in the occurrence of TBI-related hospitalizations. CDC began promoting the development of a multistate traumatic brain injury surveillance system in 1989 with funding support and technical assistance, after the Federal Interagency Head Injury Task Force Report identified the need for better information on the public health impact of brain injuries.18 The surveillance system's function is to characterize the risk factors, incidence, external causes, severity, and outcomes of traumatic brain injury in the population. Such improved data collection can help achieve two important public health goals:
In 1995, CDC published Guidelines for Surveillance of Central Nervous System Injury19 to help ensure that the multistate TBI surveillance system would generate valid and timely information representative of the U.S. population. These guidelines provide a standard case definition (Appendix I) of traumatic brain injury (craniocerebral trauma) that can be summarized as an occurrence of injury to the head (arising from blunt or penetrating trauma or from acceleration-deceleration forces) that is associated with symptoms or signs attributable to the injury-- decreased level of consciousness, amnesia, other neurologic or neuropsychologic abnormalities, skull fracture, diagnosed intracranial lesions--or death. The Guidelines also clearly define the data elements necessary to describe the occurrence and severity of these injuries, their external causes, and associated risk factors. The core of these data elements can be obtained from hospital discharge reports, which are readily available to most State health departments. The most recent developments in CDC's TBI surveillance program include the following:
In September 1997, with the help of funding provided under Public Law 104-166, CDC added 11 States to the system, bringing the total number of participants to 15. Participating States now include Alaska, Arizona, Arkansas, California, Colorado, Louisiana, Maryland, Minnesota, Missouri, Nebraska, New York, Oklahoma, Rhode Island, South Carolina, and Utah. Together, these States are quite representative of the diversity of populations found throughout the United States.
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This page last modified on 09/19/06. Privacy Notice - Accessibility Centers for Disease Control and
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