Presentation on theme: "Measuring Inflicted Traumatic Brain Injury in Minnesota"— Presentation transcript:
1Measuring Inflicted Traumatic Brain Injury in Minnesota Sara Seifert, M.P.H. & Debra HagelInjury & Violence Prevention UnitMinnesota Department of Health
2Nomenclature If we can’t name it, how can we measure it? Shaken Baby SyndromeShaken Impact SyndromeAbusive Head TraumaInflicted Traumatic Brain Injury
3Overview Minnesota Trauma Data Bank Data Sources for iTBI Strengths & Weaknesses of each Data SourceEpidemiology of Severe iTBI in Minnesota
4Minnesota Trauma Data Bank Pre-hospitalHOSPITALPost-hospital
5Hospital DataCodes assigned by medical records identify diagnoses, procedures, and injury causes.Minnesota Hospital Association compiles billing data statewide.gender, age, inpatient / ED, date, zip code, chargesMDH abstracts data from medical records.relationship to perpetrator, circumstances of injury, alcohol / drug use
6Partners Centers for Disease Control & Prevention Funding to: Identify additional casesGather new informationAssess CPS / public health cost differentialDepartment of Human ServicesMidwest Children’s Resource CenterShaken Baby Syndrome Task ForceMinnesota Department of Health
7Child Maltreatment in Minnesota FatalitiesCentral Nervous System InjuriesHospital Treated CasesOutpatient CasesSubstantiated Injury Reports to CPSSubstantiated Reports to CPS
8Data Sources Deaths Death Certificates Medical Examiner Reports Child Fatality Review PanelSupplemental Homicide ReportsFemicide ReportNewspaper Clippings
9Death Certificates “Abdominal and head injuries” StrengthsPopulation-basedPublic dataHave ICD 10 CodesWeaknessesOften no perpetrator informationOften limited information on circumstances“Abdominal and head injuries”“Multiple injuries of varying ages”“Was injured by another person”
10Medical Examiner Reports Don’t know. Anticipate much detail, especially medical.
11Child Fatality Review Panel StrengthsLots of informationPublic dataWeaknessesOnly obtain cases that are reported to Child Protective ServicesNorth Dakota Case
12Supplemental Homicide Reports StrengthsPublic dataOften have perpetrator and circumstancesWeaknessesVoluntary systemLimited detailVictim: 1 year old female, Asian, Non-Hispanic Offender: 54 year old female, white, Non-Hispanic Weapon: [blank] Relationship: Day care provider Circumstance: Victim violently shaken, causing shaken baby syndrome
13Femicide Report Strengths Weaknesses Public data Often have perpetrator and circumstancesWeaknessesBased on voluntary reporting and newspaper clippings
14Femicide Report continued 11. Austin Olson, 8 months Otsego November 7Cynthia Henderson of Rogers, 32, was charged with second-degree murder in connection with the death of Austin Olsonof Otsego, 8 months, for whom she was caring. Shortly afternoon on November 5, Henderson called 911 to report thatAustin had been injured when her own child threw a toy athim. She later told investigators A CAT scan on Austinrevealed a skull fracture and other injuries consistent withblunt force trauma and shaking injuries. An autopsy alsorevealed rib fractures. Cynthia Henderson was sentenced inJune of 2002 to 12 ½ years in prison for unintentional second-degree murder.
15Newspaper Clippings Strengths Public dataOften have perpetrator and circumstancesWeaknessesNot all cases obtain coverageCost/time“The boy’s brain injuries were consistent with violent shaking, but medical experts can’t rule out the possibility that the accidents played a role in his death.”
16Data Sources continued Inpatient Hospitalizations & ED TreatedMinnesota Hospital AssociationTBI/SCI RegistryAbstracted hospital dataLists from other sources
17Minnesota Hospital Association StrengthsIdentify potential casesHave ICD 9 codesWeaknessesCannot confirm casesUsually have no circumstance or perpetrator informationPrivate dataCost801.0 Fracture of base of skull, open with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness
18TBI/SCI Registry Strengths Weaknesses Identify casesHave ICD 9 codesUsually have perpetrator and circumstancesWeaknessesMay lack important detailPrivate data“Alleged fall from jungle gym (suspected child abuse).”
19Abstracted Hospital Data StrengthsIdentify casesHave ICD 9 codesHave most detailWeaknessesPrivate dataCostMay vary by facilityMay not be conclusive“Shaken baby syndrome with old tibia fracture. Large subdural hematoma with herniation seizure. Severe disability. Delay in seeking treatment for 16 hours although 1 month was unresponsive. Siblings removed from home. Suspected shaken baby syndrome by dad also old left tibia fracture. Child later became ward of state.”
20Abstracted Hospital Data continued “There is nothing here except 1) face sheet 2) order for full skeletal series with reason noted as suspected shaken baby syndrome 3) request from County Child Protective Services for all medical records. Lots of unknowns.”“2 subdural hematomas of varying ages. County Social Services unable to prove anything, so child discharged to home.”
21Child Protective Services Need to explore this data more.Identify TBIs, unclear if only due to iTBI and how complete.
22Clinic, Home or No Treatment No data at this time.
23Key Messages About Data Sources With some effort you can access death data for iTBI casesThe IVPU can provide summary data on inpatient iTBI hospitalizationsThe IVPU can provide more limited summary data on ED treated iTBINo data available on clinic or untreated iTBI at this time
24Major Limitations of iTBI Data RequiresIdentification,Documentation,Coding &Submission of cases.Have many unknown/unclear casesMay not obtain cases treated out-of-state
25Key Findings for Severe iTBI in Minnesota, 1999-2001 Small number of casesMajority are boysMajority are under one year of ageNearly half have documented previous abuseMost perpetrators are a parent or parent’s partnerMajority of perpetrators are male
26Severe iTBI Rates MN, 1999-2001, Ages 0-4 Note: Cases identified from Death Certificates, Abstracting TBI Cases, and TBI Registry. Actual N’s = 32, 35, and 46 respectively.
27How does Minnesota compare? Ages 0-1 CI=(33.8, 60.0)CI=(22.9, 36.7)CI=(1.78, 40.82)Note: Different case definitions and data collection methods.
28Deaths and Inpatient Hospitalizations by Gender and Age, MN, 1999-2001 66% boys82% under 1Note: Information available only for TBI Registry and abstracted cases
29Perpetrator for Inpatient Hospitalizations MN, 1999-2001, Ages 0-4 Note: Information available only for abstracted cases
30Previous Abuse for Inpatient Hospitalizations MN, 1999-2001, Ages 0-4 Note: Information available only for abstracted cases
31Hospital Charges, MN,1999-2001 iTBI, Inpatient Hospitalizations (n=66) CM, Inpatient Hospitalizations (n=58)CM, ED Treated (n=110)Mean$36,219$9,361$776Median$20,234$5,461$310Sum$2,390,476$541,912$85,573Note: Information available only for abstracted cases
32Payer Source for Inpatient Hospitalizations, MN,1999-2001 Note: Information available only for abstracted cases
33ConclusionsWe can estimate incidence of severe iTBI in Minnesota and provide descriptive information.Limited data at local level due to small numbers and lack of access to data sources other than deaths.The majority of severe iTBI victims in Minnesota are boys under age one. Nearly half have a documented history of previous hospital/ED treated abuse.