Embed Size (px)
Citation preview
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
e p
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
