1. CSTE Annual Conference ▪ June 14, 2011 Ericka Welsh, PhD Nebraska Injury Prevention and Control Program

2.  Traumatic brain injury (TBI) is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.  Each year, about 1.7 million Americans sustain a TBI; about 52,000 die as a result.  Currently, about 5.3 million Americans are living with a TBI-related disability, and 85,000 persons each year will sustain a TBI that results in a permanent disability.

3.  Created to inform public health practitioners, policymakers, and the general public about the burden of TBI in Nebraska in order to design and implement effective preventive measures against TBI.

4.  Describe the burden of TBI-related deaths, hospitalizations, and emergency department (ED) visits in Nebraska ◦ Frequencies and age-adjusted rates ◦ 5-year trends ◦ Age-specific rates ◦ Leading causes, by gender ◦ Median hospital charge and expected primary payer  Highlight current initiatives in Nebraska to prevent and control TBI

6.  Nebraska death certificates ◦ Provided by the NDHHS Office of Vital Statistics ◦ Multiple cause-of-death ◦ Classify injuries by external cause of death

7.  Hospital discharge data (HDD) ◦ Data collected via 2004 Uniform Billing form (UB- 04) ◦ Provided by Nebraska acute care hospitals to the Nebraska Hospital Association (NHA) ◦ E-code data, a subset of HDD containing injury related records, is provided to the Nebraska DHHS by the NHA

8.  TBI-related deaths and hospitalizations CDC State Injury Indicators: Instructions for Preparing 2005 Data (2007)

9. Deaths with ANY of the following International Classification of Diseases (ICD)-10 codes in ANY field of the multiple cause of death file:

10. Hospital discharges with ANY of the following ICD-9-CM diagnostic codes in ANY of the diagnostic fields of the injury hospital discharge (E-code) subset:

11.  All results are based on deaths and hospital discharges of Nebraska residents. Nebraska residents who died or were treated at hospitals out of state are not included.  Frequencies and rates reflect numbers of discharge records, rather than numbers of patients discharged.  Five-year averages are used to provide more stable rates by reducing the effects of fluctuations from year to year.

13. 30,265 ED visits 4,750 hospitalizations 1,610 deaths ??? Other medical care ??? No medical care AA rate= 17.4 per 100,000 pop. AA rate=50.9 per 100,000 pop. AA rate=337 per 100,000 pop.

18.  Increasing trends similar for 2000-2009 data  From 2000 to 2009: ◦ 115% increase for TBI-related ED visits ◦ 40% increase for TBI-related hospitalizations

19.  From 2005 to 2008 :  ~12% increase for injury-related ED visits w/out TBI, but ~52% increase for injury-related ED visits w/ TBI  Greater relative increases among certain causes: MVT, falls, struck by/against, and not specified  Greatest relative increase within “unspecified head injury” category

20. Case definitions

26. Among TBI-related deaths due to firearm injuries, 82% were suicide, 15% were homicide, and the remaining 3% were unintentional or undetermined intent.

28. Percent of TBI-related ED visits that were sports-related: 3.5% among females, 11.5% among males.

30.  From 2004 to 2008, the median hospital charge for TBI-related hospitalizations was $17,152.

31.  From 2004 to 2008, the median hospital charge for TBI-related ED visits was $1,664.

32.  From 2004- 2008: ◦ Rates for TBI-related death remained relatively stable, while TBI-related hospitalizations and ED visits increased.  Increased coding of “unspecified head injury” ◦ TBI-related death and hospitalization rates were highest among older adults; TBI-related ED visits were highest among infants, young children, adolescents, and older adults.

33.  From 2004- 2008: ◦ The leading causes of TBI-related deaths were motor vehicle crashes, falls, and firearms (esp. for males). ◦ The leading causes of TBI-related hospitalization and ED visits were falls, motor vehicle crashes, and stuck/by against injuries. ◦ For males, slightly more than 1 in 10 TBI-related ED visits are sports-related

35.  NE-BIA director is a member of the Injury Community Planning Group  DHHS working closely with NE-BIA to promote newly passed Nebraska Concussion Awareness Act

36.  Signed into law April 14, 2011  Prohibits youth who suffer concussions in school- sponsored athletics and in programs run by cities, businesses and nonprofit groups from playing or practicing until cleared by a healthcare professional  Requires that coaches receive training on the warning signs of concussion  Workgroup formed to decide how to best promote to coaches and healthcare professionals

37.  Motor vehicle crashes ◦ Distracted driving among teen drivers  Older adult falls ◦ Tai Chi: Moving for Better Balance

38.  Data support ◦ Jennifer Marcum, DrPH ◦ Alan Xu ◦ Ming Qu, PhD  Program support ◦ Peg Ogea-Ginsburg ◦ Jason Kerkman, MPH  Data providers

39.  Contact information: Ericka Welsh, PhD ericka.welsh@nebraska.gov (402) 471-1063  Website: http://www.dhhs.ne.gov/hew/hpe/Injury/facts.htm http://www.dhhs.ne.gov/hew/hpe/Injury/facts.htm