Presentation on theme: "CDC Traumatic Brain Injury Activities"— Presentation transcript:
1CDC Traumatic Brain Injury Activities Angela Marr, MPHMay 13, 2004National Center for Injury Prevention and ControlCenters for Disease Control and Prevention
2CDC MissionTo promote health and quality of life by preventing and controlling disease, injury, and disability.TBI is a leading cause of death and disability in the US. It fits within the CDC mission for TBI-related activities to be a focus for the Injury Prevention Center.
3Traumatic Brain Injury (TBI) is: A blow or jolt to the head resulting in disruption of the normal function of the brain.A blow or jolt to the head can result in a traumatic brain injury (TBI), which can disrupt the normal function of the brain. The severity of the injury may range from mild, a brief change in mental status or consciousness, to severe, an extended period of unconsciousness (30 minutes or more), prolonged amnesia after the injury, or a penetrating skull injury. Any TBI can result in short- and long-term disabilities (CDC unpublished).
4TBI Problem Impact and Magnitude of TBI in the United States: 1.5 million people sustain a TBI annuallyAt least 5.3 million people live with disabilities resulting from TBIHowever this number is likely an underestimate because it includes only persons hospitalized with TBI and not those seen only in the ED or who did not receive care for their injury. Population-based data on TBI in the US are critical to an increased understanding of the impact of TBI on public health.
5Background TBI Act of 1996 The Children’s Health Act of 2000 CDC receives $ 4 million for TBIAmong other responsibilities, CDC assigned to:Collect and disseminate information on incidence of TBI and prevalence of TBI-related disabilityDevelop an education and awareness campaignCongressional funding for CDC’s traumatic brain injury activities began with the TBI Act of 1996. Since then, CDC has supported data collection and follow-up studies in more than 15 states to track and monitor TBI, to link people with TBI to information about services, and to find ways to prevent TBI-related disabilities.
6Background 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.
7Overview of TBI Activities Analysis of national TBI dataState programsInjury Core Capacity BuildingInjury indicators reportTBI surveillanceTBI follow-upTBI linkage projectsEducation and awarenessTBI surveillance in 12 statesInjury Core Capacity Building in 28 statesInjury indicators report in 26 statesTBI follow-up registry of older adolescents and adults in SCTBI linkage projects in and COState Programs or CDC sponsored state activities.
8Analysis of National TBI Data The following information was taken from the soon to be released CDC monograph focusing on TBI in the US between
9National Data Analysis Critical to understanding the impact of TBI on public healthProvides a comparison point for statesProvides useful information for legislators and policy makersPopulation based data on TBI in the US are critical to an increased understanding of the impact of TBI on public healthNational data provides a comparison for statesProvides useful information for legislators and policy makers
10Data SourcesThe National Hospital Ambulatory Medical Care Survey (NHAMCS)The National Hospital Discharge Survey (NHDS)The Multiple Cause of Death data (MCOD)Data for the soon to be released monograph were obtained from the National Center for Health Care Statistics.Specific data sources include:The National Hospital Ambulatory Medical Care Survey (NHAMCS) for data estimating TBI-related ED visitsThe National Hospital Discharge Survey (NHDS) for data estimating TBI-related hospitalizationsThe Multiple Cause of Death data set for data on TBI-related deathsThe 3 data sources were combined to provide an estimate of the overall impact of TBI on the nation.Presents average annual numbers and rates
11Overview of TBI in the United States ??? Visiting Private Doctor orReceiving no Medical Care1,000,000Emergency Department Visits230,000Hospitalizations53,000DeathsDuring the years , an average of 1.36 million TBIs occurred in the US annually. Of these, the vast majority (79%) were ED visits, followed by hospitalizations (17%) and deaths (4%).Although more complete than previous reports, the information presented here still underestimates the occurrence of TBI in the US. Persons treated for TBI in doctors’ offices and those who do not receive any care for TBI are not included.Source: MCOD ( ) , NHDS ( ) , NHAMCS ( )
12Average Annual Rates of TBI-related Deaths, Hospitalizations, and ED Visits, by Age, United States,Very young children aged 0-4 years had the highest rate of TBI-related ED visits, followed by adolescents aged years and adults aged 75 years and older.However, the highest rates of TBI hospitalization & death occurred among those aged 75 years and older.SummaryChildren, older adolescents, and persons aged 75 years and older are more likely than others to sustain a TBI.Source: MCOD ( ) , NHDS ( ) , NHAMCS ( )
13State ProgramsThe goal of this presentation is to present the broad spectrum of CDC TBI-related activities. I started by presenting information on analysis of national data sets and now I would like to some of our state activities.
14State Programs Injury core capacity Injury indicators report TBI surveillanceTBI follow-upTBI service linkage projectsGeneral to specific
15Core 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 accessto communities andlocal organizations.About the Core State Injury ProgramInjury is a leading killer in all 50 states, but injury problems differ among the states. Because of variations in geography, weather conditions, and population groups, some states have injury issues not experienced by the rest of the country. To address these issues, CDC funds state health departments to enhance the core public health infrastructure by improving their capacity to prevent injuries and resulting deaths and disabilities. State health departments can reach local communities easier and more efficiently than federal agencies can. Building and strengthening coordinated state programs to prevent injury ensures that federal funding for injury prevention moves quickly to those who need it most.
16Core State Injury Activities Establish a focal point for injury prevention activitiesForm injury advisory councilsUse dataConduct resource assessmentDevelop state injury planThis CDC funding helps states to develop the five core components of model state injury programs:Collecting and analyzing data Providing technical support and training to communities conducting injury programsCoordinating and collaborating in injury prevention activitiesDesigning, implementing, and evaluating programs to prevent injuryInforming public policy that supports injury prevention
17Core Data Sources VR - Vital Records HDD - Hospital Discharge Data FARS - Fatality Analysis Reporting SystemED Emergency DepartmentME Medical Examiner/Coroner DataCDR - Child Death Review Team DataUCR Uniform Crime Reporting SystemEMS - Emergency Medical Services DataOPU - National Occupational Protection Use Survey DataBRFSS/YRBSS - Behavioral/Youth Risk Surveillance System14 Injuries and Injury Risk FactorsMotor Vehicle InjuriesAlcohol in MV DeathsSelf Reported Seat Belt/Safety UseHomicideSuicide/Suicide AttemptFirearm InjuriesTraumatic Brain InjuriesTraumatic Spinal Cord InjuriesFall InjuriesFire and Burn InjuriesSmoke Alarm UseSubmersion InjuriesPoisoning
18Core Injury Capacity States Core StateCurrently, there are 28 states that have one or more core state funded programs. The states shaded in pink above are funded.For more information on the Core Injury Capacity Building Program or for information on a particular state, please visit the Core Injury website.
19Injury Indicators Report CDC provides guidance to states to analyze their own injury data of which TBI is an indicatorIncludes:1999 data (2nd Edition)26 states chose to participateWe are preparing to send out guidance for version 3 of the state injury indicators report.
20State Injury Indicators Report GoalImprove state-based injury surveillance to better support injury prevention programs and policies.In September 2000, CDC’s National Center for Injury Prevention and Control agreed to coordinate the production of a surveillance report on injuries with state health departments. This unique partnership teams CDC with state health departments, STIPDA and CSTE to produce the State Injury Indicators Report.
21State Injury Indicators Report StatesParticipate in the dialogue and add knowledgeCalculate and submit data in a standardized wayUse data to affect state and local public healthCDC/NCIPCDisseminates instructions for indicator calculationCoordinates data submissionWrites text sectionsPrepares and distributes the documentUnder this partnership, CDC is responsible for facilitating the process of the report’s preparation. This includes disseminating instructions for indicator calculation, coordinating data submission from the participating states, writing the text sections, and preparing and distributing the document.Participation by state health departments in this partnership is voluntary. By volunteering, state health departments participate in the dialog and add knowledge to the process of injury surveillance. In addition, participating states also calculate and submit data in a standardized way to CDC.
22State Injury Indicators Report, Version 2 Delaware26 states participatingSuccessesStates are participating voluntarilyFosters ongoing dialogue with STIPDA and CSTEFacilitates technical assistance to statesBuilds state capacity for annual injury data analysis
23TBI Multi-state Surveillance Maintain TBI surveillance in 12 statesAll 12 collect basic data6 also abstract medical records2 conduct ED surveillance
24Surveillance is:The systematic and ongoing collection of data
25Types of Data Collected DemographicCause of injurySeverity and early outcome dataAdditional circumstances of injury information
26Data Sources Hospitalizations Deaths Multiple Cause of Death Hospital Discharge DataTrauma Registry DataTBI RegistriesMedical RecordsDeathsMultiple Cause of DeathEditedUnedited
27TBI Multi-state Surveillance Product Linked hospitalization and death dataEstimate incidence of TBIDescribe the population at riskIdentify causes of injuryInform policy development
29Examples of the Multi-state TBI Surveillance Results
30Age-adjusted TBI-related hospital discharge rates, by state The age-adjusted TBI-related hospital discharge rate for the 14 states combined was 69.7/100,000 population.The age adjusted rate varied widely by state and was highest for Maryland and lowest for Rhode Island.Factors contributing to these differences might include differences among states in 1) the actual rate of TBI occurrence 2) hospital admission practices, 3)the number of diagnosis codes that can be reported in the HDD sets, and 4) other TBI reporting and coding practices. The relative contributions of these factors have not yet been determined.MMWR Langlois, et al
31TBI-related hospital discharge rates, by age and sex -- 14 states At all ages, TBI-related hospital discharge rates were higher for males than females. The overall age-adjusted rate for males was nearly twice that of females. For both sexes rates were highest for the age-groups years and >= 65.MMWR Langlois, et al
32TBI-related hospital discharge rates, by age and race – 12 states,* Overall, age-adjusted rates were highest for American Indians/Alaska Natives and blacks, but substantial variation by age occurred. For the age groups years through years, American Indians/Alaskan Natives had the highest TBI-related hospital discharge rates. Within the age group 0-4 years, blacks had the highest rate, and within the age group >= 65 years , whites had the highest rate. For whites, blacks, and Asians/Pacific Islanders, the rate for persons aged >=65 years was substantially higher than for persons aged years. However, for American Indians and Alaska Natives, the rate for persons aged >= 65 years was substantially lower than for the other adult age groups.Rates are for 12 states with adequate reporting of race(AK, AZ, CA, CO, LA, MD, MO, NE, NY, OK, RI, SC)MMWR Langlois, et al
33TBI Follow-up StudyCDC 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 hospitalSC is currently interviewing a sample of people with TBI aged 15 years or older each yearThe initial results of these projects indicate that a substantial portion of people hospitalized with TBI have residual deficits and service needs one year after injury.A limitation of the current studies is the focus on older adolescents and adults. To truly understand the needs of children the study will need to be expanded to include this special population.CO study is completed – South Carolina study is ongoing
34CO TBI Follow-up Results 60% Reported One or More Needs Most Frequent Included:Improving memory, solving problems betterManaging stress and emotional upsetsManaging money and paying billsTraveling in the community
35CO TBI Follow-up Results Needs Least Likely to be MetFinding paid employmentImproving job skillsImproving memory, solving problems betterControlling alcohol and / or drug use
36TBI Linkage to Services The 800 number project in Colorado:Collaboration between CSU,CDPHE, BIAC, HRSA, and CDCShowed sending people with TBI a letter about an 800 number for services increased the use of the number 4 to 6 foldLinking people with TBI to information about TBI services In FY 2001, CDPHE received funds to evaluate the effectiveness of linking people in the statewide TBI surveillance system to information about TBI services. Colorado selected a random sample of 750 persons in its existing TBI surveillance system and sent them letters about a toll-free hotline to help them find TBI services. Call volume to the hotline quadrupled during the months the letter was sent out. This result indicates that people with TBI want services but may not know about them or how to access them. Callers from rural settings were overrepresented among the people who called the hotline, which may indicate that resources for TBI services are more limited for persons living in rural communities than for persons in urban settings.
37Education and Awareness Concussion brochure (English & Spanish version)Physician toolkit for educating about “mild” TBIDeveloping toolkit for high school athletic coaches
39How do CDC TBI Programs Relate to Services? Perhaps states could build “registries” byenhancing their surveillance systems to help people- find out about service needs- link to services
40Building TBI “Registries” Linking to services33Identifying(Personal identifiers and contact info)22Surveillance11
41Building 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 servicesLegal authority to identify and contact people with TBI included in surveillance allows states to link them to available services
42Possible CDC Future TBI Activities Identify people with TBI in institutionsExpand follow-up studies and include childrenExpand education and awareness efforts
43Possible CDC Future TBI Activities “Mild” TBI InitiativeResearch on how the public interprets the term “mild” TBIValidate case definitions for “mild” TBIStudy of the prevalence of disability after “mild” TBI