CDC Traumatic Brain Injury Activities Angela Marr, MPH May 13, 2004 National Center for Injury...

CDC Traumatic Brain Injury Activities

Angela Marr, MPH

May 13, 2004

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

CDC Mission

•

• To promote health and quality of life by preventing and controlling disease, injury, and disability.

Traumatic Brain Injury (TBI) is:• A blow or jolt to the head resulting in disruption

of the normal function of the brain.

TBI Problem

Impact and Magnitude of TBI in the United States:• 1.5 million people sustain a

TBI annually • At least 5.3 million people live

with disabilities resulting from TBI

Background

• TBI Act of 1996

• The Children’s Health Act of 2000• CDC receives $ 4 million for TBI

• Among other responsibilities, CDC assigned to: • Collect and disseminate information on incidence

of TBI and prevalence of TBI-related disability• Develop an education and awareness campaign

Background

• CDC’s unique role in TBI• Provides population-based

information about the importance of TBI as a public health problem at the national and state level.

Overview of TBI Activities

• Analysis of national TBI data• State programs

• Injury Core Capacity Building

• Injury indicators report

• TBI surveillance

• TBI follow-up

• TBI linkage projects

• Education and awareness

Analysis of National TBI Data

National Data Analysis

• Critical to understanding the impact of TBI on public health

• Provides a comparison point for states

• Provides useful information for legislators and policy makers

Data Sources

• The National Hospital Ambulatory Medical Care Survey (NHAMCS)

• The National Hospital Discharge Survey (NHDS)

• The Multiple Cause of Death data (MCOD)

??? Visiting Private Doctor orReceiving no Medical Care

1,000,000Emergency Department Visits

53,000Deaths

230,000Hospitalizations

Overview of TBI in the

United States

Source: MCOD (1995-1998) , NHDS (1995-1998) , NHAMCS (1995-1998)

0

100

200

300

400

500

600

700

800

900

1000

0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75+

DEATH HOSPITALIZATION ED VISIT

Average Annual Rates of TBI-related Deaths, Hospitalizations, and ED Visits, by Age, United States, 1995-

1998

Source: MCOD (1995-1998) , NHDS (1995-1998) , NHAMCS (1995-1998)

State Programs

State Programs

• Injury core capacity• Injury indicators report• TBI surveillance• TBI follow-up• TBI service linkage projects

Core State Injury Programs

• Core State Injury Programs were designed to build injury prevention and control capacity at the state level.• Allows states to tailor to their

state’s injury problems.

• States have better access

to communities and

local organizations.

Core State Injury Activities

• Establish a focal point for injury prevention activities

• Form injury advisory councils• Use data• Conduct resource assessment• Develop state injury plan

Core Data Sources

• VR - Vital Records • HDD - Hospital Discharge Data• FARS - Fatality Analysis Reporting

System• ED - Emergency Department• ME - Medical Examiner/Coroner Data• CDR - Child Death Review Team Data• UCR - Uniform Crime Reporting

System• EMS - Emergency Medical Services

Data• OPU - National Occupational

Protection Use Survey Data• BRFSS/YRBSS - Behavioral/Youth Risk

Surveillance System

http://www.cdc.gov/ncipc/profiles/core_state/default.htm

Core Injury Capacity States

Core State

Injury Indicators Report

• CDC provides guidance to states to analyze their own injury data of which TBI is an indicator

• Includes:• 1999 data (2nd Edition)

• 26 states chose to participate

State Injury Indicators Report

•GoalImprove state-based injury surveillance to better support injury prevention programs and policies.

State Injury Indicators Report

CDC/NCIPC• Disseminates instructions

for indicator calculation • Coordinates data

submission• Writes text sections• Prepares and distributes

the document

States• Participate in the dialogue

and add knowledge• Calculate and submit data

in a standardized way• Use data to affect state and

local public health

State Injury Indicators Report, Version 2

Delaware

TBI Multi-state Surveillance

• Maintain TBI surveillance in 12 states

• All 12 collect basic data• 6 also abstract medical records• 2 conduct ED surveillance

Surveillance is:

• The systematic and ongoing collection of data

Types of Data Collected

• Demographic• Cause of injury• Severity and early outcome data• Additional circumstances of injury

information

Data Sources

• Hospitalizations • Hospital Discharge Data• Trauma Registry Data• TBI Registries• Medical Records

• Deaths • Multiple Cause of Death

• Edited

• Unedited

TBI Multi-state Surveillance Product• Linked hospitalization and death

data • Estimate incidence of TBI

• Describe the population at risk

• Identify causes of injury

• Inform policy development

TBI Surveillance Programs

TBI Surveillance State

Extended TBI

ED Surveillance

Examples of the Multi-state TBI

Surveillance Results

Age-adjusted TBI-related hospital discharge rates, by state

9989 89 87 81

72 7264 64 61 59 58 57 52

0

20

40

60

80

100

MD AZ CO MO AK NY UT OK NE CA SC LA MN RI

Rat

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er 1

00,0

00

Individual States 14 States Combined

MMWR Langlois, et al

MMWR Langlois, et al

TBI-related hospital discharge rates, by age and sex -- 14 states

020406080

100120140

0-4 5-14 15-19 20-24 25-34 35-44 45-64 65+

Age (years)

Ra

te p

er

10

0,0

00

Male Female

MMWR Langlois, et al

TBI-related hospital discharge rates, by age and race – 12 states,*

•Rates are for 12 states with adequate reporting of race (AK, AZ, CA, CO, LA, MD, MO, NE, NY, OK, RI, SC)

0

50

100

150

0-4 5-14 15-19 20-24 25-34 35-44 45-64 65+

Age (years)

Rat

e p

er 1

00,0

00

White Black AI/AN Asian / PI

TBI Follow-up Study

• CDC funded CO and SC to develop methods for tracking and interviewing people with TBI yearly to find out what happens to them after they leave the hospital

• SC is currently interviewing a sample of people with TBI aged 15 years or older each year

CO TBI Follow-up Results

• 60% Reported One or More Needs Most Frequent Included:• Improving memory, solving

problems better• Managing stress and emotional

upsets• Managing money and paying bills• Traveling in the community

CO TBI Follow-up Results

• Needs Least Likely to be Met

• Finding paid employment

• Improving job skills

• Improving memory, solving problems better

• Controlling alcohol and / or drug use

TBI Linkage to Services

• The 800 number project in Colorado:

• Collaboration between CSU, • CDPHE, BIAC, HRSA, and CDC• Showed sending people with TBI a

letter about an 800 number for services increased the use of the number 4 to 6 fold

Education and Awareness• Concussion brochure (English & Spanish version)

• Physician toolkit for educating about “mild” TBI

• Developing toolkit for high school athletic coaches

CDC TBI Resources Web Page

–www.cdc.gov/injury

How do CDC TBI Programs Relate to Services?

Perhaps states could build “registries” by

• enhancing their surveillance systems to help people

- find out about service needs

- link to services

Building TBI “Registries”

Surveillance

Identifying (Personal identifiers and contact info)

Linking to services

1

2

3

1

2

3

Building on Surveillance to Link People to Services

• Surveillance data meet the needs of state service agencies for data on the numbers of people with TBI who may need services

• Legal authority to identify and contact people with TBI included in surveillance allows states to link them to available services

Possible CDC Future TBI Activities

• Identify people with TBI in institutions

• Expand follow-up studies and include children

• Expand education and awareness efforts

Possible CDC Future TBI Activities

• “Mild” TBI Initiative• Research on how the public

interprets the term “mild” TBI

• Validate case definitions for “mild” TBI

• Study of the prevalence of disability after “mild” TBI

Contact Information

Angela Marr, MPH

CDC/NCIPC

E-mail: amarr@cdc.gov

Phone:

(770) 488-1428